Application Form English – Maple Bear Belgrade

I wish to register my child as a student with you in the Maple Bear Early Learning Centre for the year*

Expected Start Date*

Requested Class*

Child Information

Child Photo

Name*

First Last

Gender*

Male
Female

Birthday*

Nationality*

Please choose a level of English*

Mother tongue*

Other languages spoken

Child Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Is your child immunized?*

Yes
No

If no please specify

Does your child have any allergies?*

Yes
No

If yes please list, including any food or drug allergies

Does your child have any medical conditions?

Does your child require any medication? If yes, please list these medications

Do you authorize us to administer the medications listed above?

Yes
No

Parent/Guardian 1 Information

Name*

First Last

Name of Employer and Position*

Phone*

Email*

Address - Same As Child?*

Yes
No

Parent/Guardian 1 Address*

Street Address Address Line 2 City ZIP / Postal Code Country

I'm the sole parent/guardian of the child*

Yes
No

Parent/Guardian 2 Information

Name*

First Last

Name of Employer and Position*

Phone*

Email*

Address - Same As Child?*

Yes
No

Parent/Guardian 2 Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Other Information

My child has attended kindergarten/day care before*

Yes
No

Name and location of kindergarten attended*

Any Comments?

How did you hear about us?*

Kindergarten Application Form (English)

Child Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Other Information

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