REGISTRATION FORM

Name of Child:

Birth Date:

Sex:

Address:

Postal Code:

Home Phone:

Child’s knowledge of Ukrainian:

Teacher Alert: (Speech or comprehension difficulties, shyness, etc.)

CONTACT INFORMATION

Primary Contact

Full Name:

Relation:

E-Mail:

Cell Phone:

Work Phone:

Contact me by: E-Mail Home Phone Cell Phone Work Phone

Secondary Contact

Full Name:

Relation:

E-Mail:

Home Phone:

Cell Phone:

Work Phone:

Contact me by: E-Mail Home Phone Cell Phone Work Phone

Third Contact

Full Name:

Relation:

Phone:

Fourth Contact

Full Name:

Relation:

Phone:

MEDICAL INFORMATION

Doctor:

Phone:

Medical Alert: (allergies, medication requirement, health concerns, etc.)

Mark classes to attend: Wednesday Mornings Friday Mornings

There is a volunteer teacher assistant needed during each class, in order to supervise the class whenever the teacher must give special attention to one child (for example, to take a child to the bathroom). To cover this duty, parents must take a turn occasionally, or you might arrange for a grandparent or other family member to help. Please indicate who will be the teacher assistant(s) for your family:

Sadochok also needs volunteers to bring food to special events, to help with Mosaic, to participate on the board.etc. Please indicate how your family can assist:

Privacy Notice: Parents signing below acknowledge and consent to Sadochok:

Providing lists of its students to sponsoring agencies to assist qualifying for grants, thereby enabling Sadochok to be offered at a moderate cost
Posting photos of Sadochok students on its web site (www.SadochokRegina.CA), or using them in its advertising, promotional materials, or other materials distributed to the children, parents, teacher, board members, and volunteers.

I Agree with the Privacy Notice

REGISTRATION FORM

CONTACT INFORMATION

Primary Contact

Secondary Contact

Third Contact

Fourth Contact

MEDICAL INFORMATION

Main Menu