Child InfoChild's Full Legal Name * Required Preferred Name Date of Birth * Required MM slash DD slash YYYY Child Lives With * Required Regular Hours of Attendance: Valid hours are from 6:30 AM - 6:00 PMDrop Off Time * Required : HH MM AM/PM AM PM AM/PM Pick Up Time * Required : HH MM AM/PM AM PM AM/PM Preferred Start Date * Required MM slash DD slash YYYY Academy Location * RequiredPlease SelectUniversity of Edmonton (College Plaza)North Edmonton (Oxford)Sherwood Park (Emerald Hills)South Edmonton (Cavanagh)St. Albert (Sturgeon)Downtown Edmonton (Sun Life Place)Glenora (West Block)West Edmonton (Westlink)Spruce Grove (West Wind)How did you hear about us? Family InfoParent/Legal Guardian #1 * Required Email Address * Required Home Address * Required Primary Contact # * RequiredSecondary Contact # * RequiredPlace of Employment * Required Parent/Legal Guardian #2 Email Address Home Address Primary Contact #Secondary Contact #Place of Employment Medical and Nutritional Information All Kepler children 13 months and older enrolled in full time care are provided our nutritional meal plan.Allergies/Sensitivities/Dietary Restrictions * RequiredPlease upload an up-to-date copy of your child's immunization record. Kepler Academy requires ALL children to be immunized according to Alberta Health Services Routine Immunization Schedule.Max. file size: 100 MB.Does your child have a medical/emotional condition? * RequiredPlease SelectYesNoPlease Explain * Required Does your child require any medical treatment or medication? * RequiredPlease SelectYesNoPlease Explain * Required Does your child require any emergency medications to be administered? * RequiredPlease SelectYesNoPlease Explain * Required Emergency Contacts Parents will be contacted first. Emergency contacts will only be contacted if parents/guardians are unavailable. Remember that your Emergency Contacts should be able to pick up your sick or injured child in a timely manner; be familiar to your child; and be someone who will have a proper car seat for your child. Emergency Contacts may also pick up your child without notice as they are emergency contacts for your family!Name of 1st Emergency Contact * Required Relationship to the Child * Required Home Address * Required Primary Contact # * RequiredSecondary Contact # * RequiredName of 2nd Emergency Contact Relationship to the Child * Required Home Address Primary Contact #Secondary Contact #Out-of-School CareAre you registering your child in our Stellar Program Out-of-School Care for children aged 6-12? * RequiredPlease SelectYesNoDo you require transportation? * RequiredPlease SelectYesNoTransportation Type * Required Stellar Transportation (Drop-off only) ($39.00 per month) Second ChoiceStellar Transportation (Pick-up only) ($39.00 per month) Second ChoiceStellar Transportation (Two Way) ($79.00 per month) In addition, we offer weekly classes by accredited professionals for an added charge in the following activities: Jiu Jitsu ($60.00 per month) Sculpture ($60.00 per month) Stop Motion ($60.00 per month) Yoga ($60.00 per month) Parental Consents Photographs I will allow the Kepler Academy Caregivers to take photographs of my child for "in house" display purposes only. Daily Child Care Communication and Progress Reports I understand my Child’s name and date of birth will be used to create an account for the Daily Child Care Communication and Progress Report that is sent via email or text message daily. Upon Registration, you will be given the Information and Guidance to sign in. Fees I understand that Child Care fees are due by the first operational day of the month for which care is required. Health Care I give permission for Kepler Academy to provide or allow for the provision of Health Care for my child. This includes First Aid and an Emergency Response Team if necessary. To all the above-noted permissions, I have NO objections.Consent Authorization * Required I authorize the above consents Signature of Parent/Guardian * Required Date * Required MM slash DD slash YYYY Please call us if you have any questions or objections about these items.Getting to Know Your ChildDo you have a favorite toy or stuffie? Do you have any pets at home? What are their names? Are you scared of anything? Do you have a favorite song or story? Do you have a favorite food? What is your least favorite food? Do you have a favorite color? Do you have a favorite animal? Do you have any Brothers and Sisters at home? How many? What are their names? Does someone in your family live far away? Are you Shy or a Party animal? What do you like to do in the evenings (examples: play sports, kindermusic)? How long do you nap for? How do you like to fall asleep (examples: cuddles, back rubbed, favorite blanket, stuffed animal)? Any special celebrations your family participates in that we could learn about? What languages are spoken, written or heard at home? Anything else you think is helpful for the Caregivers to know? We Are All Born Explorers Call Now
