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EYES Child Care Centre in Toronto

EYES Child Care Centre

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EYES Montessori Admission Package

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EYES Montessori Admission Package

EYES MONTESSORI LEARNING CENTRE NORTH OSHAWA ADMISSION FORM

1Child Information

2Health Information

3Allergy Information

4Consent

5About Child

Child Information

NAME OF CHILDCARE*

SESSION*

Full Legal Name*

Preferred Name*

Date of Birth (dd/mm/yyyy)*

Day

Month

Year

Age (years, months)*

Home Address:

Street Address*

City*

Province*

Postal Code*

Language(s) Spoken at Home*

Other children in the family enrolled in the centre (list names, if applicable)

Parent Information

Full Legal Name*

Preferred Name

Relationship to Child*

Primary Phone Number*

Alternate Phone Number

Email Address 1*

Email Address 2

Parent's Home Address same as child

Parent's Home Address Same as Child

Parent's Street Address*

City*

Province*

Postal Code*

Custody Arrangements (if applicable)

Are there custody arrangements pertaining to legal right of access to your child?*

Yes

If YES, please provide a copy of the appropriate legal documentation (e.g., court order)

Name(s) of custodial parent(s)*

Name(s) of individuals prohibited from accessing/picking up your child

Emergency Contacts

In the event of an emergency, if a parent cannot be reached, the following individual(s) may be contacted. Please list in order of preference.

Emergency Contact 1 Details

Full Legal Name*

Preferred Name

Relationship to Child*

Primary Phone*

Alternate Phone

Authorized to pick-up child*

Yes

Home Address*

City*

Province*

Postal Code*

Add More Emergency Contact Details?*

Yes

Emergency Contact 2 Details

Full Legal Name*

Preferred Name

Relationship to Child*

Primary Phone*

Alternate Phone

Authorized to pick-up child*

Yes

Home Address*

City*

Province*

Postal Code*

Emergency Contact 3 Details

Full Legal Name

Preferred Name

Relationship to Child

Primary Phone

Alternate Phone

Authorized to pick-up child

Yes

Home Address

City

Province

Postal Code

Pick-Up Authorization

The following additional individuals are authorized to pick up my child (Photo ID will be required to confirm identify before the child will be released)

1. Full Legal Name*

Relationship to Child*

Primary Phone*

More Individual Details to Pick Up My Child*

Yes

2. Full Legal Name*

Relationship to Child*

Primary Phone*

3. Full Legal Name

Relationship to Child

Primary Phone

Additional Emergency Information

Please provide any special medical or additional information about your child that could be helpful in an emergency (e.g., known medical conditions, skin conditions, vision/hearing difficulties):

If your child has had any history of communicable diseases (e.g., chicken pox, measles), please list them below (see Appendix C for common communicable diseases from Health Canada):

Does your child have any medical need(s) that requires additional support (e.g., Diabetes)?*

Yes

If yes, an individualized plan for children with medical needs must be developed between the parent and the child care centre prior to the child’s first day of care.

Immunization Records

Note: Please provide copy of updated Immunization record

Please provide a copy of your child’s immunization record (e.g., yellow card) to the centre prior to your child’s first day of care. If you do not have an immunization record, please complete the chart below.

If you have chosen not to immunize your child, a Statement of Medical Exemption form or a Statement of Conscious or Religious Belief form must be completed and provided to the centre. These forms are available on the Ministry of Education’s website.

DTaP-IPV-Hib (2mos, 4mos, 6mos, 18mos) Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b:

DTaP-IPV-Hib Dose1 Date

DD slash MM slash YYYY

DTaP-IPV-Hib Dose2 Date

DD slash MM slash YYYY

DTaP-IPV-Hib Dose3 Date

DD slash MM slash YYYY

DTaP-IPV-Hib Dose4 Date

DD slash MM slash YYYY

Pneu-C-13 (2mos, 4mos) Pneumococcal Conjugate 13:

Pnec-C-13 Dose1 Date

DD slash MM slash YYYY

Pnec-C-13 Dose2 Date

DD slash MM slash YYYY

Pnec-C-13 Dose3 Date

DD slash MM slash YYYY

Pnec-C-13 Dose4 Date

DD slash MM slash YYYY

Rot-1 (2mos, 4mos) Rotavirus

Rot-1 Dose1 Date

DD slash MM slash YYYY

Rot-1 Dose2 Date

DD slash MM slash YYYY

Rot-1 Dose3 Date

DD slash MM slash YYYY

Rot-1 Dose4 Date

DD slash MM slash YYYY

Men-C-C (12mos) Meningococcal Conjugate C

Men-C-C Dose1 Date

DD slash MM slash YYYY

Men-C-C Dose2 Date

DD slash MM slash YYYY

Men-C-C Dose3 Date

DD slash MM slash YYYY

Men-C-C Dose4 Date

DD slash MM slash YYYY

MMR (12mos) Measles, Mumps, Rubella

MMR Dose1 Date

DD slash MM slash YYYY

MMR Dose2 Date

DD slash MM slash YYYY

MMR Dose3 Date

DD slash MM slash YYYY

MMR Dose4 Date

DD slash MM slash YYYY

Var (15mos) Varicella

Var Dose1 Date

DD slash MM slash YYYY

Var Dose2 Date

DD slash MM slash YYYY

Var Dose4 Date

DD slash MM slash YYYY

Var Dose3 Date

DD slash MM slash YYYY

MMRV (4-6years) Measles, Mumps, Rubella, Varicella

MMRV Dose1 Date

DD slash MM slash YYYY

MMRV Dose2 Date

DD slash MM slash YYYY

MMRV Dose3 Date

DD slash MM slash YYYY

MMRV Dose4 Date

DD slash MM slash YYYY

Tdap-IPV (4-6years) Tetanus, diphtheria, pertussis, Polio

Tdap-IPV Dose1 Date

DD slash MM slash YYYY

Tdap-IPV Dose2 Date

DD slash MM slash YYYY

Tdap-IPV Dose3 Date

DD slash MM slash YYYY

Tdap-IPV Dose4 Date

DD slash MM slash YYYY

Inf (every year in the fall) Influenza

Influenza Dose1 Date

DD slash MM slash YYYY

Influenza Dose2 Date

DD slash MM slash YYYY

Influenza Dose3 Date

DD slash MM slash YYYY

Influenza Dose4 Date

DD slash MM slash YYYY

Other (please specify)

Other Vaccine Dose1 Date

DD slash MM slash YYYY

Other Vaccine Dose1 Date

DD slash MM slash YYYY

Other Vaccine Dose1 Date

DD slash MM slash YYYY

Other Vaccine Dose1 Date

DD slash MM slash YYYY

Other Vaccine(s)

Allergy Information

Does your child have a life-threatening allergy (e.g., anaphylactic to peanuts or bee stings)?*

Yes

If yes, an individualized plan for an anaphylactic allergy that includes emergency procedures must be developed between the parent and the child care centre prior to the child’s start date.

Does your child have any allergies that are not life-threatening (food or other substance [e.g., latex])?*

Yes

If yes, please provide relevant details, including what your child is allergic to, symptoms of a reaction and treatment required:*

Consent/Agreement Form

*Please read the following policies and procedures and initial your understanding of the policy and your willingness to abide by it by checking the box

I/We agree to read the Policy Manual of E Y E S Montessori Learning Centre North Oshawa and follow policies set out in it*

I/We agree to read the Policy Manual of EYES Montessori Learning Centre North Oshawa and follow policies set out in it.

I/We will bring our child(ren) into the EYES Montessori Learning Centre North Oshawa and greet the teacher at drop off and pickup times to exchange pertinent information and ensure supervision.*

I/We will bring our child(ren) into the EYES Montessori Learning Centre North Oshawa and greet the teacher at drop off and pickup times to exchange pertinent information and ensure supervision.

I/We will keep EYES and/or program staff informed of changes in information relevant to my child, i.e., file information such as telephone numbers, change in child’s health, unusual happenings at home etc.*

I/We will keep payments current and up to date and paid in advance. Fees are due for statutory holidays and any other absent days (for illness or any reason) and any closure of the centre in the event of an emergency*

I/We allow my child(ren) to use all the play equipment and participate in all of the activities of the program. I hereby grant permission for my child to leave the centre premises under the supervision of a staff member for neighborhood walks.*

I/We hereby consent to have my child leave the premises of the EYES Montessori Learning Centre North Oshawa from time to time, to participate in excursions to places of interest, planned as part of the children’s program. It is understood that members of the staff will provide supervision and every precaution will be taken for the safety of the child. Parents will also receive written notification prior to each full day field trip or excursion.*

I/We grant permission for the operator or designate of the EYES Montessori Learning Centre North Oshawa to take any necessary steps to obtain emergency medical care if warranted. A full outline of emergency procedures, policies and practices is in the Policy Manual. Any expenses incurred during an emergency will be the responsibility of the child’s family.*

Any parent who arrives to pick up their child after their pre-determined scheduled times will be required to pay a late fee. In the event that the parent is late to pick up their child on more than 2 occasions the family may be withdrawn from the program.*

The EYES Montessori Learning Centre North Oshawa reserves the unilateral right to cancel any arrangements, if policies of EYES Montessori Learning Centre North Oshawa are not followed by a child or parent.*

The EYES Daycare Programs and EYES Montessori Learning Centre North Oshawa will not be responsible for any incident that may occur as a result of false information given at the time of enrollment. I/We understand that my child(ren)s enrollment is contingent on all information outlined in these forms to be full and accurate.*

I/We give consent for the appearance of my/our child to appear in any publicity arranged by the EYES Daycare Programs and EYES Montessori Learning Centre North Oshawa through the various media, newspapers, radio, television, slide presentation and other publicity or educational purposes. This publicity may be in the form of photographs, video, writing pieces, and artwork with child’s first name It is felt that it is important for the community to be kept informed of activities of the program.*

Yes, I agree

No, I do not agree

We have read the above policies and fully understand all of the above information:

1. Name of Parent/Guardian*

1. Relationship to Child*

1. Date of Consent Agreement*

Day

Month

Year

2. Name of Parent/Guardian

2. Relationship to Child

3. Date of Consent Agreement

Day

Month

Year

My Classroom

My Teacher

Have been to daycare before

Yes

Home Daycare or Centre

Language Spoken at Home

Siblings

I Like or Enjoy:

My Favourite things to do are:

My fears are:

Potty Trained

Yes

How I ask to go to the Bathroom:

Need a little bit help with:

If having a bad day this is sure will cheer ME up:

We would love to hear about your Celebrations/Traditions, if you would like to share:

Other things My Teacher needs to know:

EYES Head Office:

9131 Keele Street, A4-130
Concord, ON L4K 2N1

Email: connect[at]eyeschildcare.com

Phone: (416) 901-5434

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CONTACT EYES

TESTIMONIALS

Great school and extremely happy with the care that Cheryl is getting. We can see the huge difference after we change her to the EYES. She seems to be getting much more attention, learning a lot more things and seems much more happier. Naila seems to be natural with children & you can definitely see the passion in the way she runs the school.

-Neil Dabr & Silvia George

Naila has helped me nurture and grow my kids. My daughter, Aeriel, started in 2008. Then my son, Ethan, who was born at 27 wks. EYES is always willing to learn and accept feedback to grow a positive enriched, safe and comfortable environment for the kids.

-Marsha Francis

We really appreciate Naila’s passion what she does with the children & she’s been very accommodating with our schedule.

-Phi Thu and Leslie Gittens

We are extremely lucky that my kids have Naila as their early childhood teacher. EYES not only provides a safe daycare environment but also establishes a very strong academic foundation for my kids.

-Dan & Jack

I am constantly amazed by the genuine interest and care Naila gives to our child on daily basis. Its been pleasure knowing that our child is in such a caring and capable hands.

-Shabbir and Evershine

Great school and extremely happy with the care that Cheryl is getting. Cheryl is learning a lot more things and seems much more happier.

-Neil Dabre and Silvia George

EYES established an early learning foundation for my daughter to prepare her for formal schooling. Thanks EYES

-Cathy Luo

EYES environment is great, nice and clean. I am very satisfied and would highly recommend this school for kids.

-Munira and Ali Asghar Tinwala

We are very happy and thankful to the person who referred EYES daycare. My daughter learned proper manners and to communicate . I would recommend EYES daycare to everyone.

-Fariaz and Hameeda

Mrs. Naila of EYES pioneered on her two fold approach – first by allowing each child to experience the excitement of learning by her own choice and secondly by helping her to perfect all her natural tools of learning.

-Vikram Teri

Over the past one year, we have observed a remarkable improvement in our son’s communication and learning ability under EYES care. We would highly recommend EYES to our friends for their child’s care.

-Narendra Khera and Aaradhana Khera

Naila has always been so accommodating open minded and communicated any concerns thoroughly. Our daughter absolutely loves going to EYES daycare.

-Crystal and Pino Falcione

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