Reservation

Please complete the following form in order to register for “La Maison des Mignons”. We will contact you when we received your form.

    Last name, first name of the child (obligatory)

    Birth date (yyyy-mm-dd)

    Age

    Adress

    City

    Postal Code

    INFORMATION REGARDING PARENTS :

    Mother

    Telephone number

    Alternative Telephone Number

    Email (obligatory)

    Father

    Telephone

    Alternative Telephone Number

    PEOPLE AUTHORIZED TO PICK UP CHILDREN :

    Name

    Telephone

    Relationship to child

    Name

    Telephone

    Relationship to child

    IN CASE OF EMERGENCY :

    Name

    Telephone

    Relationship to child

    MEAL TIMES :

    Does your child feed him/herself?

    Favorite Food :

    Food he/she/they don’t like :

    ALLERGY :

    Information :

    Epipen?

    TOILET TRAINED :

    Is your child toilet-trained ?

    Does he/she/they wear Pull-Ups?

    MOTRICITY :

    Does your child walk?

    Can your child sit?

    LANGUAGE :

    Language spoken at home

    Language understood

    Communicates : :

    SOCIALIZATION :

    Does your child share easily ?

    Is your child aggressive?

    Does your child have tantrums?

    Is your child ever left with a babysitter?

    NAPS :

    Does your child nap?

    If so, when (at what time)?

    Length of nap

    Does your child need a blanket, stuffed animal or pacifier in order to sleep?

    KNOWLEDGE OF THE CHILD AND OF THEIR HABITS :

    Has your child ever attended daycare?

    If so, was it a positive experience?

    Does the child have siblings?

    Do you have a pet?

    What are the child’s favourite activities (games, books, favourite toy)?

    Is your child in used to playing with other children?

    What is your child’s temperament? (likes to play alone, joyful, energetic, shy etc...)

    Have there been any major changes in the child’s life recently?

    Is your child going through any learning or developmental phase at the moment?

    What comforts and soothes your child?

    AUTHORIZATION :

    To be photographed ?

    To have sunscreen applied?

    To go outdoors?

    Thank you for collaborating with us for the well-being of your child !