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Registering is easy!

Lifestars accepts children throughout the year to attend its learning center. To register, please fill out the form below.

PERSONAL INFORMATION

FULL NAME OF CHILD(Required)
USUAL NAME OF CHID (if different)
MM slash DD slash YYYY
Gender
MM slash DD slash YYYY
ADDRESS(Required)
1ST PARENT OR GURDIAN’S NAME(Required)
2ND PARENT OR GURDIAN’S NAME(Required)
1ST PARENT’S ADDRESS(if different from above)
2ND ADDRESS(if different from above)
1ST PARENT’S WORK ADDRESS(Required)
2ND PARENT’S WORK ADDRESS(Required)

EMERGENCY HEALTH INFORMATION

CHILD’S IMMUNIZATION STATUS

IS YOUR CHILD UP TO DATE ON IMMUNIZATION?(Required)

CONSENT FOR EMERGENCY CARE

I authorize the staff at the Life Stars child care centre to call a medical practitioner or ambulance/ transport for emergency medical care, in the case of accident or illness of my child and if the parent cannot immediately be reached.(Required)

HEALTH INFORMATION

INJURY(S), ILLNESS(ES) OR OPERATIONS YOUR CHILD HAS HAD INCLUDE DATE(S) 1. Please describe any concern(s) / issues regarding your child’s health (seizures, asthma, vision, hearing, etc.) 2. Please describe any concerns you may have regarding your child’s development (Behaviour, vision, hearing, speech, language, mobility. Etc.) 3. Please include any specific care instruction regarding 1) and/or2) above.
(e.g. occupational therapist/ physical therapist)

ALTERNATE PERSONS AUTHORIZED TO PICK UP CHILD

(other than parent/ guardian listed above, include emergency pickup) Check all that apply
NAME(First One)(Required)
NAME(Second One)(Required)

PERSONS WHO ARE NOT PERMITTED ACCESS TO MY CHILD

NAME(First One)
NAME(Second One)
PHOTO, VIDEO, AUDIO CONSENT(Required)
Give my permission for my child to photographed, film and audio recorded with the understanding that the photo and video may be used by Life stars family daycare for recording or documenting. By signing this document, I expressly grant permission to the Life stars child care to utilize any photo, video recording or any other likeness of my child without prior notice or my express approval. I further understand that by signing the document, Life stars daycare will not inform me in advance of each occasion that my child’s photo, video and/ or likeness is used as described above.

SIGNATURE OF PARENT OR GURDIAN PROVIDING INFORMATION

NOTE: This information may be reviewed by Fraser Health Licensing staff as per legislation.
Name(Required)
MM slash DD slash YYYY