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Child Info

Gender *

Not required to state

Male

Female

Custody Order *

Yes

No

Custody Order File Upload *

Click or drag a file to this area to upload.

File Size

File Name

Please provide legal document related to custody order.

Parent/Guardian Info

Signature (Parent/Guardian 1) - I agree that my typed name will be as valid as a handwritten signature to the extent allowed by local law *

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Emergency Contact and Authorized Pick-up

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

Allergy and Food Restrictions

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

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Health History

Physical, Language, Cognitive Development

Immunization Records File Upload *

Click or drag a file to this area to upload.

You can upload up to 3 files.

File Size

File Name

File Size

File Name

File Size

File Name

Please provide a copy of the Immunization Records or Statement of Religious or Conscience Belief form | Statement of Medical Exemption form

Authorizations

Over the Counter Products*

Once received from the parent or guardian of a child, all over-the-counter products such as diaper cream, sunscreen, moisturizing skin lotion, lip balm, insect repellant and hand sanitizers will be deemed to have been authorized for use by staff at Lullaboo. Staff will follow manufacturer specifications and/or any instructions provided by parent to apply the product to your child.  The over-the-counter product must be received in its original container or package. 
As the parent/guardian of the above child, I authorize Lullaboo staff to apply any and all above listed over-the-counter products that have been or will be provided to the center for use according to manufacturer specifications and/or any provided parent instructions.

Will your child use over the counter product at the centre? *

No

Yes

Type of cream * N/A - No CreamAquaphorCetaphilCeraveParent's ChoicePresident's ChoiceBurt's BeesZincofaxDesitinPenatenSudocremVaselineAveeno

Body part(s) *

Legs

Arms

Face

Bum

Diaper Area

Frequency * When Bum Appears RedEvery Diaper Change

Expiration Date*

This field is required.

Over the counter Products Signature*

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Sunscreen Application Authorization*

Lullaboo does not accept sunblock with Arachidyl alcohol (peanut oil). Aveeno sunscreens other than Aveeno Baby brand have been known to include this ingredient therefore we are unable to accept them.
As the parent/guardian of the above child, I authorize Lullaboo staff to apply any and all over-the-counter products that I have provided to the center for use as per manufacturer specifications and/or any provided parent instructions. I understand that sunscreen will be applied before going outside including, but not limited to the face (except eyelids), tops of ears, nose, bare shoulders and exposed arms and legs.
*Please note parents who do not want their children to wear sunscreen yet want them to participate in our outside activities must provide sufficient protective clothing as children are still required to participate in outdoor programming.
*If you have requested for sunscreen to be applied and do not provide sunscreen you will be asked to asked to pick up your child prior to outdoor time as children are required to participate in outdoor programming.

Apply sunscreen? *

No

Yes

Type of sunscreen to use * OmbrelleLa Roche PosayAveeno BabyCoppertoneBanana Boat

Expiration Date*

This field is required.

Sunscreen Application Authorization Signature*

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Parental Consent: Rest Time*

Lullaboo provides all cribs/cots, mattress and mattress/cot sheets for your child during sleep time. All children in Toddler/preschool rooms are assigned to a cot regardless of age.

SIDS (also known as crib death) refers to the sudden and unexpected death of a healthy baby less than one year of age. Public Health Agency of Canada, the Canadian Pediatric Society do not know the cause of SIDS but they do know that you can reduce the risk of SIDS by:

♣ Laying your baby on her back to sleep and not on her stomach
♣ Having a smoke-free environment
♣ Keeping your baby warm but not hot. No duvets or comforters, sheepskin, pillows under the baby, stuffed toys in crib, and no crib bumper pads
Children younger than 12 months must be placed for sleep in a manner consistent with the recommendations set out in the document “Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada” published by Public Health Agency of Canada unless the child’s physician recommends in writing otherwise in order for Lullaboo to start following the sleep recommendation set out.
Lullaboo Nursery and Child Care Center recommends that the children sleep with no blanket during sleep time, however we respect parent wishes please complete the section below for your child.

Lullaboo will take into consideration instructions given from parents regarding their children's sleep and rest period. These instructions will be followed as closely as possible but Lullaboo also need to take into consideration the need of the individual child. For example if a parent has provided instructions for the child to not to sleep during the day but the child is falling asleep at the table, Lullaboo will provide a rest period for this child.

Would you like your toddler/preschooler child to have a nap at Lullaboo? *

No

Yes

Toddler/Preschool Sleep Time - I hereby give permission for Lullaboo Nursery and ChildCare center to use: *

Soother

Reduced Nap Time

Pillow

Stuffed Toy

Blanket

My child Sleeps on his/her: *

Side

Back

Stomach

Would you like your 12-18 months old child to have a nap at Lullaboo? *

No

Yes

12-18 months old child Sleep Time - I hereby give permission for Lullaboo Nursery and Childcare Center to use: *

Light Blanket

Sleep Sack

Swaddle

Soother

My child Sleeps on his/her: *

Side

Back

Stomach

Would you like your under 12 months child to have a nap at Lullaboo? *

No

Yes

Infant sleep time (Under 12 months) - I hereby give permission for Lullaboo Nursery and Childcare Center to use: *

Light Blanket

Sleep Sack

Swaddle

Soother

My child Sleeps on his/her: *

Back

Rest Time Signature *

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Photo*

As part of our daily programming children are involved in several adventures throughout the day. We love to share these moments with our parents, as they are essential building blocks for our children’s growth. Taking pictures is part of the pedagogical documentation to implement the Four foundations of learning. For us to be able to share these moments with you, by signing this form you are consenting for Lullaboo educators to take pictures of your child with other children in the picture and giving permission to send it home. This gives permission that your child may be in a picture that goes home with another child and gives consent for your child’s photos to appear on our displays, classroom blogs, website, social media, classroom documentation or learning portfolios.

Allow your child's photo to be taken? *

No

Yes

Photo Permission Signature*

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General Acknowledgment*

I have read, fully understand and acknowledge Lullaboo Nursery and Child Care (Lullaboo) Parent Manual available at www.lullaboo.ca and I agree with these policies and procedures. By signing and providing payment and engaging in services provided by Lullaboo, I further confirm my acceptance and acknowledgement of the Parent Manual in its entirety.

I acknowledge that all information provided on my child’s registration package is truthful and accurate and I understand that it is my responsibility to inform Lullaboo in regards to any updates to the provided information in registration package.
I understand that any person listed as Emergency Contact or Authorized Pick-up listed in my child’s profile do not have the authority to alter the child's profile information whatsoever.

In the event of medical emergency, while every possible effort will be made to reach parents, we require your permission to authorize any doctor of a necessary treatment in the event of such an emergency. Lullaboo may be required to contact emergency help before attempting to reach parents. Lullaboo will take and follow direction from emergency personal, such as 911 operator as required. Parents will be immediately notified after emergency help is notified first. I hereby consent to medical treatment being given to my child, if at any time such treatment is necessary due to circumstances such as accident, sudden illness or emergency. Lullaboo Nursery and Childcare Center and all staff members are hereby released from any liability due to circumstances and medical treatment received, as a result of such emergency.

I, THE UNDERSIGNED, REQUEST TO UTILIZE MY ELECTRONIC SIGNATURE ON LULLABOO DOCUMENTATION.

I understand that this involves the use of a computer/iPad to sign documents electronically.
I understand that my Electronic Signature is equivalent to my written signature and I shall be held responsible and legally liable for all entries made bearing this Electronic Signature. If I have reason to believe that the confidentiality of my Electronic Signature has been compromised, I will contact Lullaboo immediately. I understand that any unauthorized use or disclosure of my Electronic Signature is a breach of my confidentiality obligations and that disciplinary action may be taken which may include termination of childcare.

General Acknowledgment Signature*

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Financial*

As the parent/guardian of the above child, I hereby authorize Lullaboo Nursery and Childcare Center to debit the amount indicated for each bi-weekly payment and to treat each payment as if I had personally issued a cheque. I acknowledge that this constitutes delivery of the authorization by me to my financial institution. I acknowledge that Lullaboo requires a void cheque for auto-withdrawal. I agree to the terms and conditions listed below.

“Terms and Conditions”

· Parents are to notify Lullaboo of any changes to account information provided.
· Lullaboo will withdraw pre-authorized payment bi-weekly to cover payment due on account.
· Lullaboo Nursery and Childcare Center relies on the representation constituted by the authorization provided that the customer’s financial institution account is, and shall be, during the currency of this authorization, in good standing with sufficient funds to cover such pre-authorized withdrawals as they become due and payable.
· This authorization may be terminated at any time by parent or Lullaboo upon written notice (30 DAYS in advance). Upon termination, any balance due thereafter shall be payable directly to Lullaboo Nursery and Childcare Center. Parents are to notify Lullaboo of any changes to account information.
· Lullaboo is not required to provide pre-notification to parents, of any changes to the biweekly payment.
· EFT Canada Inc. (Payee) has been contracted by Lullaboo Nursery and Childcare Center (Entity providing the Payor Goods and Services). You the Payor, authorize EFT Canada Inc.(Payee) to debit the bank account identified.
· Note that any credit card or bank fees are not refundable.

Fee payments include statutory holidays and days your child may be absent due to illness or vacation days. No deduction will be made for any of these days in order to guarantee your spot upon return. There is no break in your child care fee at any time of the year. If you withdraw your child from the program and later want to re-enroll at any Lullaboo location, note that re-enrollments require the written approval of the District Manager. Fees are due in advance as per our fee biweekly schedule, any payment returned NSF or stop payments will be subject to a $50.00 charge. Failure to provide payment prior to start date does not guarantee your spot. No other forms of payment will be accepted. Centre specific fee charts and payment schedules are available in every centre or can be emailed to you upon request at any time as they do vary in every region.

There is a registration fee for every child that is non-refundable to be paid at all campuses. This fee is also paid annually at the Avenue and Bedford Campuses (additional credit card fees may apply). Every effort will be made to accommodate preferred start date. Lullaboo does not accept registrations made for a child who is scheduled to begin attending elementary school within twelve months. Changes to the preferred start date need to be acknowledged in writing by parent and Supervisor; any changes may result in loss of care. Note that preferred start date depends on internal center transitions. All child information and forms must be completed at least 30 days prior to your child's preferred start date. Failure to do so may result in loss of the preferred start date you've requested. Once you have paid the registration fee, you are subject to the Withdrawal and Discharge Policy which requires that parents provide 30 days written notice of withdrawal date. Note that, if you are registered in a center which is enrolled in CWELCC, a 52.75% reduction will be reflected in your fees as per regional direction. Lullaboo reserves the right to decline any registration at its discretion, immediately and at any time.

In the case of a missed payment, the following payment and NSF fee ($50.00) will be applied to the next billing cycle, amounting in a double payment plus all applicable NSF fees. If an NSF fee is incurred in the following billing cycle, all outstanding fees (regular bi-weekly payments plus NSF fees) must be paid via certified cheque within 3 business days of billing date. If a certified cheque is not submitted immediate termination will follow and a letter informing parents of the last day of care will be sent. If payments are continuously missed it is at the discretion of Lullaboo to determine whether or not to terminate service.

When changing your child’s program, i.e. moving from full-time to part-time enrollment, our fee charts are in full effect. If you choose to change the program of your child, no guarantee is made that the previous program will be available to you in the future. For example, a student that is reduced to 2 days per week for summer months is not guaranteed a full-time spot in the month of September. You will be charged on a biweekly basis once enrollment commences at the rate of the program in which your child begins the cycle in. Mid-week transitions to another classroom will not be prorated for fee credits.

In case of an outstanding balance with Lullaboo, your tax receipt may be withheld until the account is paid to date.

At any time if a tax recipient is to be reissued a $45 administration fee will be charged for a second copy.

For information on Fee Subsidy and eligibility in Peel Region visit: http://peelregion.ca/hsapply, in York Region visit: http://www.york.ca/wps/portal/yorkhome/support/yr/childrenservices/. In Simcoe County visit : https://www.simcoe.ca/ChildrenandCommunityServices/Pages/fee-assistance.aspx In Waterloo Region visit: https://www.regionofwaterloo.ca/en/living-here/child-care-subsidy-calculator.aspx

If Lullaboo becomes aware of any information that could affect a client’s ongoing eligibility for child care fee subsidy, this information will be shared with their Child Care Representative i.e. living arrangements or employment/school status.

“Canada Wide Early Learning and Child Care System (CWELCC)”

Lullaboo is enrolled in Canada Wide Early Learning and Child Care System. CWELCC is an optional program which Lullaboo can opt out of at any time; if opting out Lullaboo will provide families with notice in accordance with CWELCC agreements. The fee charts reflect approved base rates for CWELCC and are specific to each region. Fee charts and payment schedules are available in every centre or can be emailed to you upon request at any time. Please note that fee charts only include base fee and do not include any non-base fee which will be an additional charge to the fee listed in charts. If payment is not received through CWELCC, families will be responsible for paying the full fees listed in the fee chart.

“Base Fee”

The base fee is everything considered to be a mandatory charge to parent for providing childcare, including everything a licensee is required to provide under CCEYA. This includes the following but is not limited to: play materials, equipment and furnishings, meals, supervision by adults during operational hours, and development and implementation of individualized plans.

One key fob is included in the base fee for each family.

“Non-Base Fee”

Fees charged for optional items or services, or any fee where parent fail to meet Lullaboo agreement terms. This includes following but is not limited to
· Registration fees: Per child and is non-refundable to be paid upon registration (additional credit card fees may apply)
· Non-sufficient funds (NSF) fee: Any payment returned NSF or stop payments will be subject to a $50.00 charge.
· Early and late fees: An early/late fee of $1.00 per minute per child will be charged to those arriving for drop-off or pick-up either before or after program hours, on the next billing period.
· Administration fee: If a tax receipt is to be reissued, a $45 administration fee will be charged for the second copy.
· Additional Key-fob charges: Lullaboo will provide one key fob allowing you access to the Lullaboo centre that your child is enrolled in. If families would like an additional key, the cost is $50.00 per additional key which is non-refundable. There is a $50.00 fee should you lose your key and require a replacement.
· Extra-Curricular activities and field-trip charges: Parents will be notified of any extra-curricular activities or field trips in advance. Once parents inform the centre that they would like their child/ren to participate in the extra-curricular activity or filed trip, an additional cost for field trips and/or extra-curricular activity will be added to the next billing cycle.
· Center fundraisers: Lullaboo organizes various fundraisers for community organizations throughout the year including: SickKids Hospital, local shelters, local food banks, etc. Fundraisers are done in the form of raffles, toy or food drives, center activities and events (ex. summer BBQ), etc. Donations are optional and can take the form of money, services, goods, time, etc.

Financial Signature*

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