Child and Youth Registration

Our programing is funded in part by Military Family Services through the Comox MFRC and the national child care enhancement funding program. Please fill in all fields to ensure we receive all available funding to continue running these programs.

Child's Information

First Name

Last Name

Date of Birth

Gender

Photo

Please provide a current photo of your child clearly showing their face.

Primary Address

List any allergies, medical conditions, or extra supports required for your child. If none, indicate clearly.

MFRC Staff will contact you if any further information is required or in order to ensure appropriate staffing is available. We strive to be an inclusive place for everyone.

I authorize the Staff of the Comox MFRC to perform first aid on my child if required while in attendance at our programs.

I understand that medical attention or an ambulance will be called at the expense of the caregiver(s) should the Staff of the Comox MFRC determine that it is necessary.

Caregivers' Information

Caregiver 1 Name

Phone

Caregiver 2 Name

Phone

Which situation best describes your family?

Family of currently service Military Member

Family of Veteran

Family of a civilian DND employee

Family of a first responder or health care worker

Other family

Emergency Contacts

Emergency Contacts are required and MUST be different than above caregivers. If you are new to the area you can use neighbours or co-workers who may know how to get a hold of you.

Emergency Contact 1

Phone

This person is authorized to pick up my child.

Emergency Contact 2

Phone

This person is authorized to pick up my child.

Child and Youth Registration

Child's Information

Caregivers' Information

Emergency Contacts

Fill out your Privacy and Confidentiality Consent Form Remplissez votre formulaire de consentement à la confidentialité et à la protection des données personnelles.

Fill out your Privacy and Confidentiality Consent Form
Remplissez votre formulaire de consentement à la confidentialité et à la protection des données personnelles.