Enrolment Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please select which session you are applying for: Toddler program (12 months to 2 1/2years old):5 Full days (8:00am to 5:30pm)Extended Care (7:30am to 8:00am)Extended Care (5:30pm to 6:00pm)Preschool program (2 1/2 – 6 years old):5 Full days (8:00am to 5:30pm)Extended Care (7:30am to 8:00am)Extended Care (5:30pm to 6:00pm)Preferred Date of EnrolmentHealth Information Child PediatriciansNameChildname *PediatriciansAddressChildsaddressPediatriciansphone CHILDBirthdateAllergiesCHILDLanguagespokenathomeRestrictionsHas your child had any previous school experience? YesNoYesNoWhatcommunicablediseasehasyourchildbeenexposedtoCHILDIfyeswhere Please provide name(s) address, Tel. No. of person(s) who may collect your child at a short notice CHILDSchoolDurationPersonswhomaycollectyourchildatashortnotice1Mother Personswhomaycollectyourchildatashortnotice2MothernamePersonswhomaycollectyourchildatashortnotice3MotheraddressIn case of emergency, please contact MOTHERPostal_codeEMERGENCYCONTACTName1MotherHomePhonesEMERGENCYCONTACTPhone1MOTHERCellularPhoneEMERGENCYCONTACTRelationship1MOTHEROccupationEMERGENCYCONTACTAddress1MOTHERBusinessPhoneEMERGENCYCONTACTName2MOTHERBusinessAddressEMERGENCYCONTACTPhone2Motheremailaddress *EMERGENCYCONTACTRelationship2Father EMERGENCYCONTACTAddress2FATHERNameEMERGENCYCONTACTName3FATHERHomeAddressEMERGENCYCONTACTPhone3FATHERPostalCodeEMERGENCYCONTACTRelationship3FATHERCellularPhoneEMERGENCYCONTACTAddress3FATHERHomePhone FATHEROccupation FATHERBusinessPhoneFATHERBusinessAddressFatheremailaddress1 * CHILDSchoolDuration MOTHERCellularPhone EMERGENCYCONTACTName3 In order for your child’s application to be processed for enrolment it is necessary to include the following items: 1. A copy of your child’s birth certificate (record of landing/passport) 2. A non-refundable registration fee of $236.25 payable to Leaside Children’s House (Once a spot has been offered). 3. Post-dated cheques for the rest of the school year 4. A signed emergency medical treatment authorization form 5. A copy of your child’s immunization record Note: Sixty days written notice is required in the event of an early withdrawal from the school and at this time, the school will return any post-dated cheques on file. Please call in advance for space availability. Please submit this application form and mail or drop off all necessary items in an envelope. Thank you for selecting Leaside Children’s House Leaside Children’s House has a non-discriminatory policy relative to race, religion, and national origin with respect to admission of students and the employment of faculty and administrative staff. Leaside Children’s House considers the records of all individual students to be confidential information available to a child’s parents or guardians upon request. Records will only be released to other schools or agencies upon a signed request from the parent or guardian and only after all accounts due are paid in full. Submit