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Registration Form

Thank you {{_name}}. We will be contacting you via {{parents_email}} or {{parents_cell_phone}}, regarding {{first_name}}'s enrollment into Chappelle Daycare.

1

1
Step 1
Parent's name
2
Step 2
Child Info
3
Step 3
Parents/Guardian information
4
Step 4
Emergency Contact
5
Step 5
Add Another Emergency Contact
6
Step 6
Allergy and Food Restrictions
7
Step 7
Health History

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Hi

Welcome to Chappelle Daycare. This is our online registration form

Pleased to meet you {{_name}}.

Kindly fill in your child details

Program Information at start date

Full time

Part time

*Gender

Male

Female

Preferred start date

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

Yes

No

Please, provide parents/guardian information
regarding {{first_name}}'s enrolment.

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Business Information

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 *

Signature

Please, provide emergency contact information
regarding {{first_name}}'s enrolment.

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Alternative emergency contact information
regarding {{first_name}}'s enrolment.

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

Yes

No

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Does {{first_name}}'s has any allergy or food restrictions? Please tell us

*My child has Allergies?

Yes

No

*Allergies sensitivity

Strong (anaphylactic) - Requires An Epi-pen

Mild (medication on site)

*Allergic to

Peanuts

Tree nuts (Cashew, Hazelnut, Pecan, Walnut, Pistachio)

Insect stings

Egg

Shellfish

Dairy

Sesame

Medication

Others

*Other Allergies

*My child has Food Restriction?

Yes

No

*Food Restriction

Beef

Egg

Fish

Gluten

Pork

Milk

Others

*Other Food Restrictions

Finally {{_name}}, we would like to know about {{first_name}}'s health

Health Card

HS Code

Doctor's Address

Home
About
Programs
- All Programs
- Infants
- Toddlers
- Preschool
- Kindergarten
- Flex Care
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Admission
Parents
Blog
Contact Us

Menu

Home
About
Programs
- All Programs
- Infants
- Toddlers
- Preschool
- Kindergarten
- Flex Care
- Art Program
Admission
Parents
Blog
Contact Us

+1 541-754-3010

Book a Visit

780-250-5222

Home
About
Programs
- All Programs
- Infants
- Toddlers
- Preschool
- Kindergarten
- Flex Care
- Art Program
Admission
Parents
Blog
Contact Us

Menu

Home
About
Programs
- All Programs
- Infants
- Toddlers
- Preschool
- Kindergarten
- Flex Care
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Admission
Parents
Blog
Contact Us

Interactive Form

Thank you {{_name}}. We will be contacting you via {{contact_method}}, regarding your {{product_selection}}.

1

1
Step 1
Parent's name
2
Step 2
Child Info
3
Step 3
4
Step 4

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1

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Hi

Welcome to Chappelle Daycare. This is our online registration form

Pleased to meet you {{_name}}.

Kindly fill in your child details

Radio Buttons

Male

Female

Please give a short description of the requirements
regarding your
{{product_selection}}.

Thank you {{_name}}.
How would you like to be contacted?

Email

Phone

Skype

+1 541-754-3010

Home
About
Programs
- All Programs
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- Toddlers
- Preschool
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Blog
Contact Us

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Alberta, Canada
Google map

Phone: 780-250-5222
kids@chappelledaycare.ca

Opening Hours: Mon-Fri, 6am-6pm

Registration Form

Thank you {{_name}}. We will be contacting you via {{parents_email}} or {{parents_cell_phone}}, regarding {{first_name}}'s enrollment into Chappelle Daycare.

1

1
Step 1
Parent's name
2
Step 2
Child Info
3
Step 3
Parents/Guardian information
4
Step 4
Emergency Contact
5
Step 5
Add Another Emergency Contact
6
Step 6
Allergy and Food Restrictions
7
Step 7
Health History

0%

https://chappelledaycare.ca/wp-content/plugins/nex-forms

true

message

https://chappelledaycare.ca/wp-admin/admin-ajax.php

https://chappelledaycare.ca/gallery

yes

1

fadeIn

fadeOut

Hi

Welcome to Chappelle Daycare. This is our online registration form

Pleased to meet you {{_name}}.

Kindly fill in your child details

Program Information at start date

Full time

Part time

*Gender

Male

Female

Preferred start date

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

Yes

No

Please, provide parents/guardian information
regarding {{first_name}}'s enrolment.

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Business Information

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 *

Signature

Please, provide emergency contact information
regarding {{first_name}}'s enrolment.

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Alternative emergency contact information
regarding {{first_name}}'s enrolment.

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

Yes

No

*Relationship to child

*Authorized to pick-up child

Yes

No

Home Address

Does {{first_name}}'s has any allergy or food restrictions? Please tell us

*My child has Allergies?

Yes

No

*Allergies sensitivity

Strong (anaphylactic) - Requires An Epi-pen

Mild (medication on site)

*Allergic to

Peanuts

Tree nuts (Cashew, Hazelnut, Pecan, Walnut, Pistachio)

Insect stings

Egg

Shellfish

Dairy

Sesame

Medication

Others

*Other Allergies

*My child has Food Restriction?

Yes

No

*Food Restriction

Beef

Egg

Fish

Gluten

Pork

Milk

Others

*Other Food Restrictions

Finally {{_name}}, we would like to know about {{first_name}}'s health

Health Card

HS Code

Doctor's Address

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