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Phone +1 403-991-2136

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About Us
Our School Program
Pages
- Our Teachers
- Gallery
Contact Us

Giving your child the best start in life

#1110 - 20 Dawson Wharf Mount, Chestermere, AB T1X 0L3

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Monday to Friday: 6.30 am – 06.00 pm

Saturday, Sunday: Close

Email: info@chestermerestarkids.com

Phone: +1 403-991-2136

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Student Information

Child's Full Name *(Required)

Child's DOB *(Required)

Child's Gender *(Required) MaleFemale

Child's Address * (Required)

City *(Required)

State/Province *(Required)

ZIP/Postal Code *(Required)

Country *(Required)

Email Address *(Required)
Please enter the email address that you would like correspondence to be sent to.

Enrolment Information

Desire Start Date *(Required)

Which Program You want to Enroll *(Required)

Time Session *(Required) AMPM

Parent Information

Father Information

Father's Name (Required)

Father's Phone Number *(Required)

Father's Email Address *(Required)

Father's Address * (Required)

City *(Required)

State/Province *(Required)

ZIP/Postal Code *(Required)

Country *(Required)

Mother Information

Mother's Name (Required)

Mother's Phone Number *(Required)

Mother's Email Address *(Required)

Mother's Address * (Required)

City *(Required)

State/Province *(Required)

ZIP/Postal Code *(Required)

Country *(Required)

Emergency Information

PLEASE ENTER AN EMERGENCY CONTACT OTHER THEN CHILD'S PARENTS. REGISTRATIONS WILL NOT BE ACCEPTED IF THIS IS NOT FILLED OUT CORRECTLY.

Emergency Contact Name *(NOT the childs parents) * (Required)

Emergency's Phone Number *(Required)

Emergency's Address * (Required)

City *(Required)

State/Province *(Required)

ZIP/Postal Code *(Required)

Country *(Required)

Student Health Information

Child's Health Care Number *(Required)

Doctor's Name *(Required)

Doctor's Phone Number (Required)

Does your child have any allergies?(*) YesNo

If so, please list them below and what a typical reaction is like.(If you choose No, please write NA in the box.)

Is your child vaccinated? *(Required) YesNo

If yes, are the child's vaccinations up to date? *(Required) YesNo

Is your child on any regular medications? *(Required) YesNo

If yes, please describe(If you choose No, please write NA in the box.)

Does your child have any medical conditions or learning disabilities? * YesNo

If yes, please describe(If you choose No, please write NA in the box.)

Does your child have difficulty with any of the following? * SpeechHearingVisionNONE

If yes to any of the above, please describe:(If you choose No, please write NA in the box.)

Is there any other relevant health information about your child that we should be made aware of (past or present)? *

General Consent/Permission

I give Chestermere Star Kids permission to..

Take photographs of my child for display in the program * YesNo

Use photgraphs/videos of my child for use on Chestermere Star Kids' website/social media, and for marking/promotional purposes * YesNo

Display my child's art work in the program for parents, visitors and staff to see * YesNo

Walk my child to and from any off-site activities such as nature walks, park, etc. within the community. * YesNo

To carry out all necessary emergency evacuation procedures as well as fire drills while my child is in their care * YesNo

By signing below, I confirm that I:
Give consent for my child to participate in the assessment and intervention services provided by Rockyview & District Primary Education Society / ECI Learning Academy. * YesNo

First Aid/Medical Transportation

In the event of an accident/incident Chestermere Star Kids' will provide first aid as needed by a certified first aider. * Agree

In case of a medical emergency, Chestermere Star Kids' will call 911 for immediate medical help for my child * Agree

Health Risks

I do not hold Chestermere Star Kids' liable for my child being exposed to any communicable diseases during the time my child is attending the program * Agree

In case of a medical emergency, Chestermere Star Kids' will call 911 for immediate medical help for my child * Agree

Chestermere Star Kids' Policies

I have read, understood, and agree to all policies set out by Chestermere Star Kids' in the parent handbook * Agree

I understand that the registration fee and deposit are NON REFUNDABLE * Yes

Signature

Please sign and date below that the information you have provided in this registration form is correct.

Signature *

Please type your name (Required)

Date *(Required)

PLEASE NOTE THAT UPON REGISTRATION A 1 MONTH DEPOSIT (EXCLUDING ANY SUBSIDIES) AND REGISTRATION FEE OF $50 IS REQUIRED. NO SPOT WILL BE GUARANTEED UNTIL COMPLETED REGISTRATION FORM AND FEES ARE RECEIVED. FEES CAN BE EMAIL TRANSFERRED TO CHESTERMERESTARKIDSPAY@GMAIL.COM

All submitted registrations will be answered and responded to by Chestermere Star Kids in a timely matter. Please be sure to check your junk email folder if you have not seen an email come through.

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