Child Registration

Lullaboo
$
Child Registration

Select Campus

Campus

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Child Info

Child Name *
First

Last

Date Of Birth (YYYY-MM-DD) *

Family Court Order File Upload *

Click or drag a file to this area to upload.

File Size

File Name

Please provide legal document related to Family Court Order.

Campus *

Preferred Start Date (YYYY-MM-DD) *
(Preferred start date depends on internal center transitions)

Program Information at Start Date *
Full Time

Would you like to be notified if an earlier start date is available? *YesNo

Parent/Guardian Info

Parent/Guardian Name *First

Last

Email *

Relationship to child *

Authorized to pick-up child *Yes No

Home Phone *

Cell Phone *

Work Phone *

Home Address *

Business Information *

Would you like to add an another Parent/Guardian contact details? Yes No

Emergency Contact and Authorized Pick-up

Note: Emergency contact MUST be someone other than parent/guardian

Contact Name *First

Last

Home Phone *

Cell Phone *

Relationship to child *

Home Address *

Do you want to receive email communication? *Yes No

Would you like to add another Emergency contact and Authorized Pick-up?

Yes No

Allergy and Food Restrictions

My child has Allergies? *
Yes No

My child has Life Style Food choices? *
Yes No

My child has Food Restrictions? *
Yes No

Will your child be under 12 month old upon start at the centre? *
Yes No

Order	Instructions for Infants under 12 months	Action
No data available in table
Sort	Emergency Actions

Order	Instructions for Infants under 12 months	Action
No data available in table
Sort	Emergency Actions

Order	Instructions for Infants under 12 months	Action
No data available in table
Sort	Emergency Actions

Instructions/Actions
All ingredients will accompany the product, I'm cautious of allergens.
Follow hunger cues
Try feeding when showing signs of fussiness
Recipe for Mixing Formula and Milk: Mix 1/2 formula with 1/2 homo milk
Feeding Schedule for Formula/Milk: Approximately 3 bottles daily 3-6 hours apart
Feeding Schedule for Formula/Milk: Provide bottle with every meal

I hereby confirm that this allergy, food restriction and feeding practice information (as applicable) for my child is accurate and up to date.
Food Restriction and Feeding Practice Signature

Name On Account *

Billing Amount *Selected Amount:

Branch Transit Number *This is a 5 digit number which identify your bank branch

Institution Number *This is a unique 3 digit number that identify your Bank

Bank Account Number *This is your account number at the bank. It is usually a minimum 7 digit long.

Void Cheque *

Click or drag a file to this area to upload.

File Size

File Name

Secondary Payment

Since a billing amount of less then 100% is selected above, we will require Secondary Payment information for the remaining balance.

Name On Account (#2)

Branch Transit Number (#2) This is a 5 digit number which identify your bank branch

Institution Number (#2) This is a unique 3 digit number that identify your Bank

Bank Account Number (#2) This is your account number at the bank. It is usually a minimum 7 digit long.

Void Cheque (#2)

Click or drag a file to this area to upload.

File Size

File Name

Pay Registration Fee For*

Payment Options *Pay registration feeI already made the registration fee payment OR I have a code

Name on Card *Your card will only be charged for the Registration Fee Payment.

Date (YYYY-MM-DD) *

Emergency Contact and Authorized Pick-up

Allergy and Food Restrictions

Bottle Feeding

Packaged Baby Food

Written Instruction For Children Under 1 Year

Health History

Child's Doctor’s Name *

Doctor's Phone *

Doctor's Address *

Select the Communicable Diseases *

Physical, Language, Cognitive Development

What type of support do you believe would be beneficial for your child? *

Do you have private insurance? *

Immunization Records *

Immunization Records File Upload *

Secondary Payment

➤ Brampton – Churchill

➤ Brampton – Homestead

➤ Brampton – Queen

➤ Brampton – Wanless