Online Enrollment

Online Enrollment Form

Child Full Name

Date of Birth

Gender

Preferred Start Date *

Program / Age Group *

Home Address

Address Line 1

Address Line 2

City

Postal Code

Province

Alberta Health Care Number (Optional)

Parent / Guardian Information

Parent/Guardian 1 Name

Relationship to Child

Phone Number

Email

Occupation / Workplace (Optional)

Parent/Guardian 2 (Optional)

Parent/Guardian 2 Name

Phone Number (Secondary)

Email Address (Secondary)

Emergency Contact

Contact Name

Someone other than parents.

Relationship

Phone Number

Authorized for Pickup

Yes
No

Health & Medical Information

Family Doctor’s Name

Doctor’s Phone Number

Dietary Phone Postal

Allergies / Dietary Restrictions

e.g., nuts, diary, gluten

Medical Conditions / Medications

Any Special Needs or Additional Support

Authorized Pick-Up Persons

Full Name

Relationship

Phone Number

Enrollment Details

Desired Schedule

Full-time
Part-time
Morning
Afternoon

Any Specific Notes or Requests

Payment & Consent

Registration Promotion

I understand that my spot will be confirmed upon payment of the first month’s deposit.
I consent to my child’s photos being used for internal or promotional purposes.
I agree to High Hopes Academy’s policies and privacy terms.