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admin
2019-11-06T21:01:10+00:00
2019-2020 Infant Application
General Information
Child's Name
*
First
Last
Birth Date (dd/mm/yyyy)
*
DD slash MM slash YYYY
Present Age
*
Please enter a number from
0
to
30
.
Gender
Male
Female
Parent's Names:
Father's Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Mother's Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Telephone Numbers:
Home Tel:
*
Father's Cell Phone
*
Father's Email
*
Father's Occupation
*
Father's Employer
*
Father's Work Address
*
Father's Work Phone Number
*
Mother's Cell Phone
*
Mother's Email
*
Mother's Occupation
*
Mother's Employer
*
Mother's Work Address
*
Mother's Work Phone Number
*
Parent's Marital Status
*
Married
Divorced
Separated
Widowed
Emergency Contact
Name
*
First
Last
Phone
*
Relationship to Student
*
Student Profile
Languages spoken at home
*
Please upload a current photo of your child.
Max. file size: 64 MB.
Medical Information
Doctor's Name
*
First
Last
Doctor's Phone Number
*
Doctor's Address
*
Diagnosis (if applicable)
*
Please list all diagnosis
Do any of the following apply to your child:
*
Seizures
Heart Condition
Respiratory Issues
Feeding Issues
Hearing Issues
Low Muscle Tone
Other Medical Condition
Does your child have any allergies?
*
Yes
No
If yes, please list:
Please list all prescribed medications child is currently taking
*
My child's Immunization Form will be
*
uploaded here
sent in to the school office
Please upload immunization records here.
Max. file size: 64 MB.
I allow KCC to share immunization information with York Region Public Health Department.
*
Yes
No
Does your child have any specific Dislikes/Fears that we should be aware of?
*
Good tips to know
My child has had a formal assessment from by a qualified health care professional.
Physiotherapist
Speech Therapist
Occupational Therapist
Other
Assesments will be
uploaded here
sent in to the school office
Please upload assessments here.
Max. file size: 64 MB.
Photo Release
*
Photos help KCC share the success of the program with potential families and our generous supporters. At no time will children's names and/or personal information be shared along with the photos without written consent. We greatly appreciate families who consent to a photo release.
You may photograph my child for use in brochures, media and website
My child may be included in group photos only
Please contact me before using my child's photo in print material
My child is not photo released
Terms and Conditions
*
I confirm the information in this application is complete and accurate.
I understand that this will be followed by an intake interview
Captcha
Phone
This field is for validation purposes and should be left unchanged.
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