Registration Information

Location & Program Selection

Select Location *

Edmonton Edmonton Centre Location

Leduc Leduc Centre Location

Program Required *

Before School Care After School Care Full Day Care Preschool Summer Care School Break Care

Days Required *

Monday Tuesday Wednesday Thursday Friday

Requested Start Date *

How did you hear about us?

Child Information

Child's First Name *

Child's Last Name *

Date of Birth *

Gender *

Alberta Health Care Number

School Attending

Grade / Room #

Home Address *

City *

Postal Code *

Is your child toilet trained? *

Yes No In Progress

Parent / Guardian Information

Parent / Guardian #1 (Primary)

First Name *

Last Name *

Relationship to Child *

Email Address *

Home Phone

Work Phone

Cell Phone *

Employer / Company

Work Address

Parent / Guardian #2 (Optional)

First Name

Last Name

Relationship to Child

Email Address

Home Phone

Work Phone

Cell Phone

Is there a custody agreement we should be aware of?

No Yes (please attach court order)

Emergency Contacts & Medical Information

Emergency Contacts (Other than parents)

Emergency Contact #1 *

Full Name *

Relationship *

Phone Number *

Emergency Contact #2

Full Name

Relationship

Phone Number

Medical Information

Family Doctor / Physician

Doctor's Phone Number

Does your child have any allergies?

No Yes

Does your child have any medical conditions, disabilities or special needs?

No Yes

Does your child require any prescription medications?

No Yes

Immunization — Is your child up to date?

Yes No Not Sure

Authorization & Permissions

Persons Authorized to Pick Up Child

List all persons (other than parents/guardians listed above) who are authorized to pick up your child. Photo ID will be required. Your child will NOT be released to anyone not listed below or above.

Person 1 — Full Name

Relationship

Phone Number

Person 2 — Full Name

Relationship

Phone Number

Person 3 — Full Name

Relationship

Phone Number

Person 4 — Full Name

Relationship

Phone Number

Consents & Agreements

Parent / Guardian Signature

Full Name (Electronic Signature) *

Date *

By typing your name above, you agree that this constitutes your legal electronic signature certifying all information provided is accurate and that you agree to the Kidz Junction policies.

Review & Submit

Please review your registration details below before submitting. Our team will contact you within 1–2 business days to confirm enrollment and discuss next steps.

Your summary will appear here once you complete all steps.

What Happens Next?

You will receive a confirmation email shortly after submission.
A Kidz Junction coordinator will contact you within 1–2 business days.
You may be asked to submit supporting documents (immunization records, custody order if applicable).
Enrollment is confirmed upon receipt of the first month's fee.

Your information is secure and will only be used for enrollment purposes.

Registration Information

Online Registration Form

Location & Program Selection

Child Information

Parent / Guardian Information

Emergency Contacts & Medical Information

Authorization & Permissions

Review & Submit

Fee Schedule

Transportation

Why Choose Us?