Sign Up Your Child To Our Daycare

Fill out the form below to begin the registration process.
If you would like to download and email the form to us, click the link: Registration Form to fill and send as an attachemnt to

  1. Click the link above.
  2. Download and save the form to your desktop.
  3. Print and fill in the form.
  4. Attach to an email and send us an email to or schedule an appointment for a daycare viewing.

Note: You must have Adobe PDF Reader to fill in the form; you can download it here: Adobe Download

    Daycare Registration Form

    Applicant Info

    Applicant Name: Applicant Phone: Applicant Email:

    Parent Infomation

    Mother or Guardian Information

    Mother/Guardian First Name: Mother/Guardian Last Name:
    Marital Status: Home Address:
    City: Province: Postal Code:
    Home Phone: Cell Phone:
    Work Phone: Employer:
    Email Address: Mother/Guardian To Pick Up Child?

    Father or Guardian Information

    Father/Guardian First Name: Father/Guardian Last Name:
    Marital Status: Home Address:
    City: Province: Postal Code:
    Home Phone: Cell Phone:
    Work Phone: Employer:
    Email Address: Mother/Guardian To Pick Up Child?


    Child Profile

    First Name: Last Name:
    Middle Name: Nick Name:
    Date of Birth: Gender:
    Age: Start Date:
    Number of Siblings: Childs Home Address:
    Childs Home Phone: Legal Guardian:

    Childs Medical/Physical Information

    Family Doctor: Office Phone:
    Address: City:
    Province: Postal Code:
    Alberta Health Care Card Number: Immunizations Up to Date:

    Allergies (please describe):

    Medical Issues, Past Surgeries, Current Illness:

    Child’s typical reaction to stress:

    Are there health, behavioural, developmental or other concerns that we should know about your child:

    Please use the space below to include any additional concerns and requests:

    Emergency Contact Information

    Alternate Contact Name 1: Relationship to Child/Parent:
    Home Address: City:
    Postal Code: Home Phone:
    Cell Phone: Work Phone:
    Alternate Contact Name 2: Relationship to Child/Parent:
    Home Address: City: Province: Province:
    Postal Code: Home Phone:
    Cell Phone: Work Phone:

    Please list the full name, relationship, and phone number of any additional people you wish to authorize for pick-up:

    Please list the full name, and relationship of any people that DO NOT have authorization to pick up your child:


    Emergency Treatment Consent

    It is our policy of notifying a parent when a child is ill or needs medical attention. Occasionally, we cannot contact a parent and we need to get immediate help for the child. Our procedure is to call 911 immediately.

    I, hereby give consent for my child when ill/injured, to be taken to the nearest emergency center by the staff of my child's daycare when I cannot be contacted. I consent to an ambulance being called to transport the child, if necessary. I further agree to pay all costs incurred for transport.

    Health Care Consent

    Child Care Regulation 11 requires every license holder who agrees to provide health care to a child only if (a) written consent of the child’s parent has been obtain via this form; (b) the health care provided is in the nature of first aid.

    I, hereby give consent and authorize the staff of the Rockabye Daycare to administer health care when needed in the nature of first aid.

    Medication Administration Consent

    If applicable; Child Care Regulation 10(1) requires every licensee who agrees to administer medication to a child to: (a) obtain prior written authorization to administer the medication from the child's parent; (b) medication is in original labeled container; & (c) medication is administered according to labeled directions. (2) ensure written records of each dose of medication administered to a child are maintained via the Medication Administration Form.

    Name of Medication:


    Times of day to be administered:

    I, hereby authorize staff of the Rockabye Daycare to administer the above named medication in the dosage and the times of day indicated to the above named child.


    The parent and Rockabye Daycare agree that child care services will be available for the indicated below weekly schedule.

    # of Days Per Week: Start Time: End Time:

    If part time, please select days: MonTueWedThuFriDrop In

    Rockabye Daycare Policies

    Monthly Fees

    Daycare fees are calculated on an annual basis and are subject for review every quarter. Invoices are issued on the 26th of each month for the following months care. Childcare fees are due within 14 days of the issue date.


    If childcare subsidy is required it is the parents responsibility to ensure that their childs subsidy status is approved and in good standing prior to starting at the daycare. We will not apply the subsidy until it has been approved. Subsidy is paid directly to us on your behalf by the Alberta Human Services Childcare Subsidy Department. You are responsible for any difference between the subsidy amount paid to us and the amount as described on this invoice. We review these amounts monthly. Subsidy amount are not negotiable.

    Late Fee Policy

    If fee's are not provided within the due date of the invoice sent, a 50$ late fee will be incurred every week that it is overdue and at the discretion of management.

    Drop Off & Pick Up Policy

    Children MUST be dropped off no later than 10 A.M. Children MUST be picked up no later than 5:30 p.m. Late fees will incur at $5 for every 15 minutes and after 15 minutes $1 per minute will be charged.

    Registration Fee

    I understand that there is a non-refundable registration fee of $150.00 to be provided upon enrollment.

    Termination Notice

    I understand that there is a 30 day termination notice is required to withdraw your child from Rockabye Daycare. We also reserve the right to refuse care of your child. This includes any reason the Director and/or license holder deems necessary. This could either be late fees, or not being able to meet child’s needs, illness, etc. In such case, you will be given a termination notice from the center.

    Off-Site Activity Permission

    I understand that field trips and walks to neighbourhood areas and parks are part of the programming and I hereby give consent for my child to participate in these activities. I will not hold my daycare provider responsible for any injuries or doctor bills while using toys, going for walks or playing at the nearby playground, as long as children are being supervised and all the toys are in good shape. Any broken toys will be fixed and if not fixable immediately discarded.

    Parental Consent For Field Trips

    I acknowledge that I have spoken with my child about my child’s need to comply with the specific rules and requirements established for this activity; all Rockabye’s policies and procedures; rules of conduct set forth in the Parent Handbook. I understand that all Rockabye rules and policies apply to my child and the other students during the course of the field trip. My child, has permission to participate in outdoor activities and trip to the park during normal daycare hours and as described the weekly excursion exercise on the Rockabye Daycare website. I understand that this activity involves travel to and from community parks via walking across the street.

    Parent Handbook Agreement

    I have carefully read the Rockabye Daycare Parent Handbook available online at and understand that it is my responsibility to be aware of all the procedures and expectations set forth by the centre in this document.

    Child Discipline Policy

    I have read the Rockabye Daycare Child Discipline Policy located at and understand that if my child is sent home with an incident report on a recurring basis it is my responsibility to mitigate the situation and it may become necessary for the daycare to terminate our childcare agreement.

    Biting Policy

    I have read the Biting Policy as outlined in the Parent Handbook, and understand that if my child is sent home for severe biting incidents three times a week for two consecutive weeks, it may become necessary for the daycare to terminate our childcare agreement. If the biting appears to target another child specifically, or causes serious damage to the other child’s body (possible scarring, loss of skin or tissue), it will be grounds for immediate termination of care.

    Developmental Screening Permission

    I give permission to monitor my child’s development, and include it in my child’s portfolio and administrative records.

    Technology, Visual, and Video Permission Form

    At our centre we try to give a variety of learning experiences. This may include the use of a computer, a video, the television, or taped recordings of their own voices, etc. as a means of an activity. All activities, including the use of the computer, will be of appropriate age and content. We require your written consent on the form below to signify your permission for these types of activities. In regards to the use of computers, television, video, and taped recording, I give the staff at Rockabye Daycare permission to include my child in such related activities.

    Telephone Release Permission (optional)

    Other parents sometimes request a family's phone number so they can phone to invite your child to a birthday party or some other social event. Please sign below if you have no objections to the release of your phone number for this purpose.

    Indemnity Agreement

    Both the parties, Rockabye Daycare and the Parent of one or more children who are attending the daycare that is operated on the premises of the Russian Greek Orthodox Church at 905 8 Ave Ne, Calgary Ab, T2E0S2; agrees and acknowledges that the daycare is not operated or managed in any way by the church. Each party agrees to hold harmless the church and any of its staff or members against any and all liability and from any and all claims.

    Photograph Permission Form (optional)

    I give the Daycare consent to take and use of any photographs in which I or my child(ren) appear for the use of daycare activities, social media, and the Rockabye Daycare website. Parents will be further advised of the use of photographs prior to any publishing or posting.


    I, , hereby agree to the terms, conditions & policies laid out in this document. I have read and understood Rockabye Services Inc. Policies and Procedures 2017 which is also available to me online and/or in the parent handbook.

    Sign Below (with mouse or finger):

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