Thank you for registering for a program with Common Digs. Please fully complete all sections of the following form and submit.

Child's Name

First Name

Last Name

Registering for:

Location

Birthdate

YYYY

Alberta Health Care#

This is optional but helpful in an emergency situation. Please out N/A if you prefer not to provide it.

Parental Information

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Email Address

Cell Phone

(###)

###

####

Parent/Guardian's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

2nd Parent/Guardian's Name

Please add N/A into the fields if single-parent/guardian family.

First Name

Last Name

Cell Phone

Please add N/A into the fields if single-parent/guardian family.

(###)

###

####

Email Address

Please add N/A into the fields if single-parent/guardian family.

2nd Parent/Guardian's Address

Please complete if different than above address or put 'SAME AS ABOVE' if same address. Please add N/A into the fields if single-parent/guardian family.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

emergency contact

Please provide a local contact, other than a parent, who will be able to pick up your child in the event of an emergency.

Emergency Contact

First Name

Last Name

Primary Phone #

(###)

###

####

Alternate Phone #

(###)

###

####

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are your child's immunizations current?

Your child does not need to be immunized to attend our program.

Yes

Does your child have any allergies or medical conditions?

Yes