Emergency Contact Update Form

Contact / Emergency Update

Please fill out your information below so we can update your child’s file regarding all contact and emergency phone numbers. Please fill out the form regardless of whether or not you have changed any phone numbers so we can ensure we have up to date information. Thank you.

Requesting For*
- Updates to My Registered Child
- Adding a New Child to my Family
Child Name*
First Last
Date of Birth
Address
Street Address City Postal Code
Program
Start Date
Parents Contact Info
In case of any changes please provide following information
Mother's Work Phone
Mother's Cell Phone
Fathers Work Phone
Fathers Cell Phone
Child's Medical Info
Please complete the following section
Health Care #:
Doctor's Name & Phone Number
Provide the Doctor Name and Phone Number Please
Child's medical info
Health care #, Doctor's Name, Allergies, Medications, General Medical Concerns, Ongoing Therapies & Services
Alternative Person To Call in Case of Emergency
Please provide your new emergency contact and authorized pick up person.
Contact #1:
First Last
Phone
Contact 1 Relationship
This Person Is Also Authorized to Pick Up Child
- Yes
Contact #2:
First Last
Phone
Contact 2 Relationship
This Person Is Also Authorized to Pick Up Child
- Yes
Captcha

About Parkland Players

Parkland Players was established in 1995 to fill a community need for quality daycare and education. Our child care centers have been founded on the philosophy that children, their families and the community benefit from high quality Early Childhood Programs. We strive to allow each child to openly explore their individual interests through a variety of programs. Over the years, we have been active members of our Coquitlam Community by taking part in various community events.

Contact / Emergency Update

Parents Contact Info

Child's Medical Info

Alternative Person To Call in Case of Emergency

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About Parkland Players

Our Locations

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604-670-8830 Ext.201