APPLICATION FOR GREENLAND CHILDCARE CENTRE ENROLMENT

CHILD’S PARTICULARS

PARENT’S / GUARDIAN’S PARTICULARS

Mother / Guardian

Father / Guardian

Home Address

Income

CHILD’S MEDICAL RECORDS

Type of vaccination & immunization ( please bring along your child’s health booklet)
Past Medical History

Physical Disabilities

Allergies, If so, how does it manifest itself?

INFORMATION ABOUT YOUR CHILD

AUTHORIZED PERSONNEL TO FETCH CHILD BESIDE BOTH PARENTS

EMERGENCY CONTACT