Please enable JavaScript in your browser to complete this form.Registration FormLynnwood Centre Out of School Care Registration FormChild's Name *FirstLastDate of Birth (dd-mm-yyyy) *Gender *MaleFemaleAddress *Start Date (dd-mm-yyyy) *1. Parent/Guardian *FirstLastRelationship to Child *Address *Work Phone *Cell Phone *Home phone *Email *2. Parent/GuardianFirstLastRelationship to ChildAddressWork PhoneCell PhoneHome phoneEmail3. Emergency Contact Person (Other than Parents/Guardians), can also pick up the child *FirstLastRelationship to Child *Address *Work PhoneCell Phone *Home phoneEmail 4. Emergency Contact Person (Other than Parents/Guardians), can also pick up the child FirstLastRelationship to ChildAddressCell PhoneEmail4. Who else is allowed to pick up your Child other than parents/guardian (Name, Address, Phone)? *5. State any Allergies? *6. Is your child's immunization up to date? *YesNo7. Is your child on special medication? *NoYes8. If 7 above is 'yes', please explain *9. What else do we need to know about your child?10. Child's School and Address *Child's Grade *KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6School Schedule *11. Choice of Care *Before and After School CareBefore School OnlyAfter School OnlyHow did you hear of Blossom HeightsFlyers in MailFacebookInstagramTwitterGoogle SearchWord of MouthStreet SignsSignature (Please type your name and the date) *CommentSubmit