2026 Municipal and School Board Elections - Notice of Nomination for Office

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Township of North Huron

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Children Programs Infant Additional Registration and Health Information form.

Child's name

In Case of Emergency Contact (Name, Telephone #, Relationship to Child.

My Child can be Release to:

Other Children in the family: Please list Name, Age and Sex.

Other Adults living in the home: Please list Name and Relationship.

Billeting: As our winter weather is unpredictable, we need the name of a friend/relative in Wingham with whom your child could stay should he/she be stranded in town due to a storm. Please list Name, Address, Telephone # and Relationship to Child.

Health Information

Does your child suffer from any medical problems?

Yes

No

If yes, please list special instructions.

Has your child had Chickenpox?

Yes

No

Please list any special needs which the teachers should be aware of (ex. Special Equipment, etc.):

Does this child have any condition which might make for a classroom emergency, such as: convulsions, epilepsy, fainting, diabetes, asthma?

Does your child require prescription medication to be taken on a regular basis?

Yes

No

If yes, please describe.

Would any of the above prevent the child from engaging in normal school activities?

Do you have any concerns regarding the following:

Hearing and/or vision?

Speech and language development?

Gross motor skills?

Overall development?

Other

If any of the above are checked please describe.

Sleeping

Please describe your child's usual bedtime/nap routine.

What position does your child sleep (ex. Stomach, back, side)?

Does your child like to be cuddled, carried, walked or rocked in a rocking chair?

Eating

What are some of your child's favourite foods?

Does your child have any strong likes/dislikes?

Does your child eat with:

Hands

Spoon

Fork

Does your child eat independently?

Yes

No

What does your child use to drink?

Sippy Cup

Regular Cup

Do you breast feed your child?

Yes

No

Does your child drink: Whole milk, 2% goat, soy, lactose free milk? At what temperature? From a cup or bottle?

Toileting

Is your child self-sufficient in using the toilet?

Does your child wear a diaper or pull-up at naptime?

Township of North Huron
Box 90,
274 Josephine Street
Wingham, Ontario
N0G 2W0

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