ABORIGINAL HEAD START ON RESERVE PROGRAM REGISTRATION FORM

ABORIGINAL HEAD START ON RESERVE PROGRAM REGISTRATION FORM
ABORIGINAL HEAD START ON RESERVE PROGRAM REGISTRATION FORM 2020-2021

Child Identification

Gender: *

Parent(s) / Guardian(s):

Please list names and ages of your child's brothers and sisters

List names of people who have authorization to pick up / drop off your child(ren) from Head Start (other than parents or emergency contacts)

Health & Nutrition

Is your child's immunizations up to date?
NOTE: Each child utilizing the Bigstone Cree Nation Head Start Program must be up to date in their immunization. This precaution is for the health and safety of your child.
Drinks from: *
Food: *
Any allergies (food, drinks, and materials)? *
Does your child have a dietary restriction?
If your child has dietary restriction, you are requested to provide alternatives to our menu. Please bring them in the morning.
Is there any health problems that may be serious or require special attention?

Nap Time / Quiet Time: Does your child nap during the day? *
When: *
:
Does your child have a security blanket? *
Does your child had previous Head Start or Daycare experience? *
Does your child have any difficulties with speech, hearing, etc.? *
Does your child speak and/or understand Cree? *
Does your child have any special interests? *
Is your child afraid of anything? *
Does your child throw tantrums? *
Parents are encouraged to volunteer time in the Head Start Program, as Parental Involvement is one of the components of the Aboriginal Head Start On Reserve Program. Would you be willing to volunteer some time?
Is there a particular time/day that is best suited to you?

CHILD'S SKILLS

Colors *
Use writing tools for doodling, etc. *
Communicates in complete sentences *
Pasting *
Reads *
Brushes teeth *
Feeds self *
Wash self *
Dresses self *
Ties laces on shoes *
Potty trained *
Plays well with others *

Field Trips

Is your child permitted to go on supervised field trips while in the BCN Aboriginal Head Start On Reserve Program? *

FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY COPYRIGHT RELEASE FORM

I hereby grant permission to Aboriginal Head Start On Reserve (AHSOR), on behalf of my child(ren) for the following: (Please check appropriate boxes) *