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info@tinylanterns.ca
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About Us
Our Daily Routine
Parents & Educator’s Forms
Child Registration
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About Us
Our Daily Routine
Parents & Educator’s Forms
Child Registration
Contact Us
Find Us
Jl Cempaka Wangi No 22, Jakarta
Opening Hours
Mon - Fri : 09.00 AM - 03.00 PM
About Us
Our Daily Routine
Parents & Educator’s Forms
Child Registration
Contact Us
About Us
Our Daily Routine
Parents & Educator’s Forms
Child Registration
Contact Us
Book a Visit
Child Pre-registration
Form
Tiny Lanterns Childcare
Instructions:
Please complete this form with accurate information about your child. All fields are required unless otherwise stated.
1. CHILD’S INFORMATION
Full Name
Date of Birth
Gender
Male
Female
Home Address
City
Postal Code
Primary Language Spoken at Home
2. PARENT/GUARDIAN INFORMATIONLIFICATIONS
� Primary Parent/Guardian
Full Name
Relationship to Child
Phone Number
Email Address
Employer
Work Phone Number
� Secondary Parent/Guardian (if applicable)
Full Name
Relationship to Child
Phone Number
Email Address
Employer
Work Phone Number
3. EMERGENCY CONTACTS (OTHER THAN PARENTS)
1st Emergency Contact
Full Name
Relationship to Child
Phone Number
2nd Emergency Contact
Full Name
Relationship to Child
Phone Number
4. MEDICAL INFORMATION
Health Card Number (if applicable)
Family Doctor’s Name
Doctor’s Phone Number
Does your child have any allergies?
Yes
No
If yes, please specify
Does your child require any medications?
Yes
No
If yes, please specify
Has your child received all required immunizations?
Yes
No
Any medical conditions or special needs?
Yes
No
If yes, please explain:
5. CHILD’S ROUTINE & PREFERENCES
Is your child toilet-trained?
Yes
No
In Progress
Does your child have any food restrictions or preferences?
Yes
No
If yes, please specify
Does your child have any sleep routines or nap preferences?
6. AUTHORIZATIONS
Medical Consent: In case of emergency, I authorize Tiny Lanterns Childcare staff to seekmedical attention for my child.
Photo & Video Consent: I give permission for my child’s photos/videos to be used forinternal documentation.
Pick-Up Authorization: I allow the following individuals to pick up my child (if different from emergency contacts)
Full Name
Relationship to Child
Phone Number
7. PARENT/GUARDIAN SIGNATURE
I confirm that the information provided is accurate and up to date.
Parent/Guardian Signature:
Date
I accept that I am sending the message to https://tinylanterns.com
SUBMIT
� Please submit this form along with any required documents (immunization records, medical notes, etc.) at the moment of the formal registration.
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