Program/Care Required:
Preferred Payment Method:
If yes, please provide more information:
If yes, please provide more information about medical condition and medication:
Please provide details of major operation:
Do you have concerns about your child's development?:
Please list any allergies and signs and symptoms associated with a reaction:
Does your child have any special behaviours or habits we should be aware of?:
Marital Status:
Siblings:
Please provide details of custody arrangement (if any) we should be aware of:
Any special cultural celebrations at home?:
Parent/Legal Guardian Consent and Agreement - Medical
As the Parent/Legal Guardians), I give consent to have my child receive first aid care by the staff of Kids Pointe Daycare & OSC. I/We understand
that medication will only be administered to my child only if a Medication Administration form has been filled out by me. If this form is not filled
out, I will be responsible for administering my child's medication. All medications must have the pharmacy label attached and staff will only follow
the directions of the label, which should match the medication administration form. We store medications in a secure box (refrigerated and
non-refrigerated) that will be located within the child's room (refrigerated medications will be kept in the closest fridge in a lockbox).
If a medical emergency requires staff to call Emergency Medical Services (9-1-1), all costs not covered by insurance will be the sole responsibility
of the child's parent/guardian. I give responsibility to my emergency contact person to act on my behalf until I am available. I also understand
the importance and will ensure all contact information will be updated immediately if there are changes. I also agree to review this information
every six months.