ENAGB Registration

To be a part of this initiative, please take a moment to register.

Application Form

Privacy Statement

All information shared is sent confidentially to ENAGB and is protected by law, Miigwech.

Guardian # 1 Information:
Address
YYYY slash MM slash DD
Marital Status
Guardian # 2 Information
Address
YYYY slash MM slash DD
Marital Status
Childs Information
YYYY slash MM slash DD
Epi Pen
Additional Children Information: (If more than one)
Full Name
Date of Birth
School/Daycare Info
Health Number
Allergies
Reactions to Allergies
 
Emergency Contact Information
In the event of an emergency, I authorize the ENAGB Early ON’s to assist me in seeking emergency medical attention for my child or me including but not restricted to calling for ambulance service, contacting the above mentioned doctor, or taking my child or me to the local hospital emergency room.
Transportation Incentive Put a check mark to which applies based on definition below, either token or Uber if you need assistance to get to the programs

Tokens: For caregivers that require less than 30 minutes on TTC services from the programs address of 16 Phin Ave

Uber: For caregivers that require more than 30 minutes on TTC services from the programs address of 16 Phin Ave

  • Google Maps will be the ONLY source for confirmation to determine the eligibility.

I understand the policies and procedures and agree to abide by them in order for my family to attend to the ENAGB EarlyON’s.

I understand that I will be notified of any changes to the Policies and Procedures at ENAGB EarlyON’s.

I acknowledge the information provided above and confirm the information I provided was correct at the time of registration and will provide changes when necessary.

Clear Signature
Clear Signature
YYYY slash MM slash DD
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