Milestone Education Center Early Learning & Inclusive CarePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please tick the age group you are enrolling your child in: *Infant (3–12 months)Toddler (1–3 years)Inclusive Program (All ages)Kindergarten (3–6 years)SECTION 1: CHILD’S DETAILS Full Name of Child *FirstMiddleLastDate of Birth *Gender *FemaleMaleHome Address *Address Line 1CityState / Province / RegionStarting Date *SECTION 2: PARENT/GUARDIAN DETAILS Primary Contact: Name of Parent/Guardian *FirstMiddleLastRelationship to Child *Phone *Email *Emergency Contact (other than parent): support Birth option Name of Emergency Contact Person *FirstMiddleLastPhone *Relationship *SECTION 3: HEALTH & DEVELOPMENT Allergies: If 'Yes', list: *YesNoList Allergies *Medical conditions or medications: If 'Yes', list: *YesNoList medical condition or medication required *Is your child immunized? If 'Yes', attach record *YesNoAttach Record Click or drag a file to this area to upload. Special needs, support required, or therapies involved: *SECTION 4: GROUP-SPECIFIC REQUIREMENTS INFANTS (3–12 MONTHS) Please Bring: 2–3 sets of spare clothes (labelled) Baby formula or breast milk (clearly labeled) Bottles Nappies, wipes, and barrier cream (e.g., Sudocrem) Blanket and pillow Preferred nap schedule (if any): Feeding instructions: Carry bag for dirty clothes TODDLERS (1–3 YEARS) Please Bring: Spare clothes (labelled) Lunchbox and drink bottle Nappies and wipes (if not yet potty trained) Pillow and blanket for nap time Personal toy (optional – for comfort) Potty training status:In ProgressTrainedPreferred learning or play style: INCLUSIVE PROGRAM (ALL AGES) Please share: Diagnosis (if any): Type of support needed (e.g., speech therapy, visuals, routines):Communication method: VerbalSign LanguageHand GesturesOtherPlease ListTriggers/soothing techniques used at home: Staff may contact you for an individual education/behavior plan. KINDERGARTEN (4–6 YEARS) Please Bring: Backpack with lunchbox Drink bottle Change of clothes Small pillow for rest time Observations: SECTION 5: DOCUMENT CHECKLIST Please attach copies of the following: Birth Certificate of Child * Click or drag a file to this area to upload. Parent/Guardian Photo ID * Click or drag a file to this area to upload. 1 Passport-Sized Photo of Child * Click or drag a file to this area to upload. SECTION 6: CONSENT & SIGNATURE Do you give consent for MEC to take pictures of your child and use on our social media platforms such as our Website, Facebook, Instagram and YouTube? *YesNoYou may ask us to remove any social media post that you do not find appropriate at any time relating to your child.Declaration *I hereby declare that the information provided is true and complete. I agree to follow MEC's policies and give permission for my child to participate in all age-appropriate activities.Signature of Parent/Guardian: * Clear Signature Upload Electronic Signature Click or drag a file to this area to upload. (optional)Date: *"Let us know how you heard about Milestone Education Centre by choosing an option below." *FacebookInstagramYouTubeFlyerNewspaperFrom a FriendSocial Media AdsSubmit Registration
