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Have Questions About Our Daycare?

Whether you have questions about our programs, need help with enrolment, or just want to learn more about our daycare, feel free to reach out.

Executive Director

Kylie Bolack

(204) 873-2060 (office)

(431) 268-0202 (cell)

Box 235, Crystal City, MB, R0K 0N0

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Parent's Name *

Email *

I have a question about:

Infant
Pre-School
School-Age
Joining Our Waitlist
Other

Questions or message *

Address

240 Crystal Avenue, Crystal City MB

Get directions

Join Our Waitlist

Looking to enroll your child? Add your name to our waitlist and we’ll be in touch with next steps. We’re happy to answer any questions along the way!

Childs Legal Name *

First

Middle

Last

Email *

Languages Knowen/Spoken

Name Commonly Known As

Gender

Male
Female

Childs Age

Childs Date Of Birth

Family Health Number

Childs Personal Health Number

Doctors Name

Doctors Phone Number

Parent Name

Relationship To Child

Mother
Father

Home Address

Home Phone #

Cell #

Home E-mail

Work E-Mail

Work Name

Work Address

Work Phone #

Parent 2 Name

Relationship To Child

Mother
Father

Home Address

Home Phone #

Cell #

Home E-mail

Work E-Mail

Work Name

Work Address

Work Phone #

Child Lives With

Mother
Father
Both
Other ( Explain )

Explanation Here

If Applicable, are there any separation agreements, court orders or other documents setting out custody arrangements for the child?

Have copies been provided to the child care facility?

Yes
No
Will be provided
Will not be provided

Are you aware that the child care facility cannot ask the police to enforce custody arrangements if the documents are not provided?

If applicable, are there any informal custody arrangements? Please describe.

Arrival Time

Departure Time

Additional Information

Bottle feeding and schedule

Does your child have allergies to food, animals or medication?

Describe if yes

If so, are the allergies life-threatening ( anaphylaxis )

Describe if yes

Are there any cultural, religious or personal requirements or restrictions that we should be aware of?

Describe is yes

Childs Toileting

Completely capable of using toilet
In diapers all the time
In underwear during day
Asked to use the toilet
Will use the toilet if not taken
Will not use the toilet yet

Other toileting information

I want my child to nap

My child usually naps from _____ to _____ time.

If applicable, how is your infant put to sleep? (ie, put in crib, rocked)

I want my child to rest on a cot each day ( if yes child will rest for no more then 30 minutes )

I have read the parent policy manual. I understand and agree to abide by these policies.

I have read the code of conduct. I understand and agree to abide by the code of conduct.

I give permission for my child to be observed by students in fields relevant to the field of child care if these observations are kept in confidence and used only as a means to fulfill their course requirements. These observations must be approved by the Facility.

I give permission for outings (not requiring transportation in private or public vehicle).

I give permission for indirect supervision as described in the parent manual.

Yes
No
Not, Applicable

I give permission for photographing and videotaping for purposes described in the parent manual.

I give permission to Crystal City Community Daycare Inc. to apply Sunscreen SPF 30+ on my child during the season when children are at risk of skin damage from the sun. I am aware that the Facility will post signs notifying me of this action in advance of the season.

I give permission to the Crystal City Community Daycare Inc. to apply insect repellent on my child during the season when children are at risk of insect bites. I am aware that the Facility will post signs notifying me of this action in advance of the season.

Emergency Medical Transportation and Treatment. If, at any time, medical treatment is necessary due to a serious injury or sudden illness, I authorize the child care facility to take whatever emergency measures deemed necessary for the protection of my child while in the care of the child care facility. I give permission for my child to receive medical attention deemed necessary by my child’s doctor or other medical personnel. I understand that this may involve transportation to the hospital in a private vehicle or ambulance. I understand that the facility will make every attempt to contact me and that any expense incurred for such treatment, including ambulance fees, is my responsibility. The daycare will not be responsible for anything that may happen as a result of false information given at the time of enrollment or by any information not updated by the parent or guardian.

Submission Date

Signature ( Print )

Parents Name

Submission Date

Signature ( Print )

Parents Name