Hilltop Daycare Centre
160 North Bonnington Ave. • Scarborough, ON M1K 1Y1 • Tel: (416) 266-1085  Fax: (416) 266-5572

ENROLLMENT APPLICATION
  
Child's Information
Family Name:   First Name:
Name to be Used:   Sex: Male  Female
Address:   Apt.:
City:   Postal Code:
Date of Birth: Day   Month   Year   Present Age:
Parent or Guardian Information
Mother's Name: Father's Name:
Home Address: Home Address:
Home Phone: ( ) Home Phone: ( )
Name of Business: Name of Business:
Business Address: Business Address:
Business Phone: ( ) Business Phone: ( )
Emergency Contact if Parents/Guardians Cannot be Reached
Name #1:   Relationship:
Home Phone: ( )   Business Phone: ( )
Address:
Name #2:   Relationship:
Home Phone: ( )   Business Phone: ( )
Address:
Medical Information
Child's Health Card #:
Doctor's Name:   Phone: ( )
Address:
Other Information
Please include any information regarding allergies, diet, physical or special needs, etc.:
List other children living in the home by Name, Relationship, and Age:
Previous experience in preschool groups or private care:
Name of School or Person:
Date Attended: Starting Month Starting Year

Ending Month Ending Year
Persons authorized to pick-up child:
Name #1:   Relationship:
Home Phone: ( )   Business Phone: ( )
Name #2:   Relationship:
Home Phone: ( )   Business Phone: ( )
Under no circumstances will any child be released to anyone not known to this centre without verbal or written authorization from the parents/guardians.

I hereby make application to enroll the abovementioned child in Hilltop Daycare Centre Inc. and I understand and agree to abide by all policies and regulations of the Centre.
Mother/Guardian Signature:
  Date:
Father/Guardian Signature:
  Date:
Witness:
  Date:
Position:
  Date:
For Office Use Only
Date:

Program Fee:
+ Admin Fee:
Amount Due:
  Amount Received:
Date of Admission:
  Date of Withdrawal:
Staff Taking Application:
  Position: