First Name Last Name Nickname Date of Birth Languages Spoken Street Address (line1) Street Address (line 2) Postal Code City Male or Female? Male Female TALK ABOUT YOUR CHILD (example: Describe their favorite song, book, or animal, a funny or special habit, etc..) Hours of child care required (Academini hours are 7:30 am to 6:30 pm) Full Day Half Day Afternoon Half Day Morning Desired Date From MONDAY MORNING AFTERNOON TUESDAY MORNING AFTERNOON WEDNESDAY MORNING AFTERNOON THURSDAY MORNING AFTERNOON FRIDAY MORNING AFTERNOON SATURDAY PARENTS NIGHT-OUT MORNING AFTERNOON DAYS REQUIRED Morning: 07:30 - 12:00 Afternoon: 13:30 - 18:00 PICK-UP SERVICE DROP-OFF SERVICE * Additional fees applicable * Not applicable every Satuday PARENT ́S INFORMATION Mother/Father Parent ́s/Guardian ́s name Mother/Father Parent ́s/Guardian ́s name Phone Number Phone Number Place of Work Place of Work E-mail Address E-mail Address Social Insurance Number (SIN) Social Insurance Number (SIN) Emergency Contact 1 (Other than parent) In the event of an emergency, please contact First Name Last Name Primary Phone Number Secondary Phone Number Emergency Contact 2 (Other than parent) In the event of an emergency, please contact First Name Last Name Primary Phone Number Secondary Phone Number Other people authorized to pick up your child from Academini First Name Last Name First Name Last Name Medical Information Doctor Doctor ́s phone number Insurance/Health Coverage (Public/Private) Insurance/Health Coverage Number Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns. * A 50$ Non-Refundable (fully applicable) Waitlist Fee Due * A 200$ Annual Administrative & Registration Fee is payable once placement is confirmed. Prior to your child’s enrolment both the parents and the child must schedule a time to visit and spend time in the classroom where your child will attend. This allows for a more secure transition into the program. DISCLAIMER Academini Private Daycare does not promise or guarantee spaces offered to parent(s), Guardian (s) or Caregiver(s) at its facility. Acceptance is granted following an admission process. The admission process involves an interview between the Parent(s), Guardian(s) or Caregiver(s), the Child and Director at our facility. It is the sole responsibility of the Parent(s), Guardian(s) or Caregiver(s) to provide us with accurate information before proceeding with an interview. Payment options will be presented to the Parent(s), Guardian(s) or Caregiver(s) after application has been submitted. Uniforms are part of our internal policy, they must be worn and purchased only at Academini's uniform store. No substitute days will be granted due to annual vacations taken or in case of illness for either full time or part time children. A two weeks written notice must be submitted to management before the termination of our services. Parents Consent for Child’s photo usage Yes No Parents Consent for Child’s activity/outing Yes No If you have any further questions please contact us at 514-945-5111 or e-mail us at info@academini.ca * All fields must be filled We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Disclaimer and Application Process Agreement: I agree and accept the terms imposed by the application process information and by the disclaimer * Yes No * Please note you must agree and accept the terms in order for us to process Click here to download required file & send it after sign... Click here to download required file & send it after sign...
