Akiva Academy Daycare/Before and After School Care

Registration Package 2016 – 2017

5776 - 5777

140 HADDON ROAD SW CALGARY, ALBERTA T2V 2Y3 TELEPHONE NUMBER: (403) 259-2808 FAX NUMBER: (403)258-3812 EMAIL ADDRESS: [email protected] WEBSITE: www.akiva.ca

*one per family*

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE Registration Policy and Procedure Policy Parents must agree to respect the values and philosophy of the Daycare/Before & After School Care and to abide by its policy and procedures. Please see Parent Handbook for details. Registration Process Please call the director at (403)259-2808 and arrange a visit to the daycare. You may visit the room and arrange for your child to spend some time in care prior to registration. Please note that registration can also be completed on our website at www.akiva.ca.

2016 - 2017 Fee Schedule Daycare Mon-Thurs Fridays Early Dismissal Fridays

Mon-Fri PD Days Drop In

11:20am-6:00pm $5,200/year 11:20am-4:00pm 11:20am-3:45pm 11:20am-3:30pm $3,775/year 8:00am-6:00pm $25/PD Day Any time during Day $10/hour

Before and After School Care $1020/year or Mon-Fri 7:30am-8:20am $10/day Mon-Thurs 3:30pm-6:00pm Fridays 3:30pm-4:00pm $2,140/year Early Dismissal Fridays 2:30pm-3:45pm Early Dismissal Days 11:20am-6:00pm $25/day PD Days Mon-Thurs 8:00am-6:00pm $45/PD Day PD Days Fridays 8:00am-4:00pm $45/PD Day Any time during Day $10/hour Drop In

10 Postdated cheques must be submitted to the office upon registration to ensure a spot for the year. P.D. Day Programs are available. Financial Assistance is available. A minimum of One Full Month’s Notice in writing prior to the withdrawal of child(ren) of this centre. Initial:_________ I understand that the centre is closed on the following days: Jewish Holidays, Summer/Winter/Spring breaks, Labour Day, Thanksgiving Day, Remembrance Day, Family Day, and Victoria Day. Closing times may change according to Sunset Hours or Daylight Savings Time. Initial:_________

*one per child*

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE 2016 – 2017 I hereby make application for the admission of my child to the: Daycare Daycare Mon-Thurs 11:20-6:00 Mon-Fri 11:20-3:30 Fridays 11:20-4:00 $3,775/year Early Dismissal Fridays 11:20-3:45 $5,200/year

After School Care Mon-Thurs 3:30-6:00 Fridays 3:30-4:00 Early Dismissal Fridays 2:30-3:45 $2,140/year

Before School Care Mon-Fri 7:30-8:20 $1020/year

Commencement Day:___________________________

Surname: _________________________________

Given Name: _____________________________

Names must be exactly as stated on birth certificate.  Male

Birthday: __ __ /__ __ /__ __ Y Y /M M/D D

Age: _________ as of date of care

____________________________ Parent’s Signature

____________________________ Parent’s Name (print)

 Female

________________________ Date

ENCLOSE THE FOLLOWING WITH YOUR APPLICATION PACKAGE OR ARRANGE WITH THE SCHOOL ADMINISTRATOR TO HAVE IT COPIED 1.

LEGAL DOCUMENTS: (Copies of all applicable documents)  Birth Certificate/Passport  Adoption Order  Custody Order  Canadian Citizenship Doc.  Citizenship _______________________ (if other than Canadian)  Permanent Resident/Landed Immigrant Doc. / Visa  Immunization Record

2.

 10 postdated cheques payable to Akiva Academy Daycare: dated the 1st of each month, through June 1, 2016. OR 

Monthly Pre-Authorized Debit. Please see office for form.

*first child only*

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE EMERGENCY CONTACT Student Information Surname: Given Name: Date of Birth: Alberta Personal Health Number: Home Street Address: City: Postal Code: Immunization (photocopy of immunization records must be submitted to office): Up to date We choose not to/cannot immunize Allergies or other medical conditions: Mother’s Information Full Name: Home Street Address (if different from above): City: Home Phone Number: Email Address: Daytime Address: Street Address: City: Daytime Number: Father’s Information Full Name: Home Street Address (if different from above): City: Home Phone Number: Email Address: Daytime Address: Street Address: City: Daytime Number:

Child Lives with Parent?

Yes No

Postal Code: Cell Phone Number:

Postal Code:

Child Lives with Parent? Postal Code: Cell Phone Number:

Postal Code:

Emergency Contact Information (different from parents) Full Name: Relationship to Child: Home Street Address: City: Postal Code: Home Phone Number: Cell Phone Number:

Yes No

*one per child*

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE Emergency/Medical Consent From time to time, a medical emergency may arise with respect to a student during Daycare/Before & After School hours. In order that these emergencies may be dealt with in a manner acceptable to all, kindly provide the school with the following information: Have we your permission to: A. Call a doctor?  Yes No B.

Call an ambulance or taxi if the emergency warrants it and efforts to contact a parent/guardian have proven unsuccessful? Yes No

Medical: Is your child physically challenged? If yes, check boxes:  Hearing  Vision  Speech  Movement Describe Medical Issues: ______________________________________________________________________________ ______________________________________________________________________________ ***Please include documentation if applicable***

Is there any medication taken on a regular basis? Yes No If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ *** If prescription medication needs to be given out at school, please see the office for a Medication Application and Release Form***

Can emergency medication be taken? (EpiPen, Inhaler, etc.) Yes No If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ ***EpiPens and Inhalers may be kept in the office for quick access in the event of an emergency***

Any other conditions Akiva should be aware of? ______________________________________________________________________________ ______________________________________________________________________________ My signature indicates that my child is aware of the arrangements we have made in the event of an emergency. ______________________ Parent’s Signature

______________________ Parent’s Name (print)

__________________ Date

*one per family*

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE Media Release Form 2016 - 2017 We are constantly updating our advertising material which includes pictures on the Akiva website. No student names will be published in connection with any photos. Please help us by filling out the form below and returning it to school. I allow my child(ren)’s photo to be used in the advertising and promotional materials of the Akiva Academy Daycare and Before & After School Care (this may include school activities, UJA promotional videos, website, newsletters, or other forms of media: Yes No Child(ren)’s Name(s): 1. ____________________________ 2. ____________________________ 3. ____________________________ 4. ____________________________ 5. ____________________________

Grade(s): _________ _________ _________ _________ _________

AKIVA ACADEMY DAYCARE / BEFORE & AFTER SCHOOL CARE Annual Trip Authorization 2016 - 2017 I understand that Akiva Academy Daycare and Before & After School Care (which includes Principal, teachers and duly appointed chaperones) arranges excursions or tours which, in the opinion of the school, have definite educational, athletic, or cultural value and are an integral part of Akiva Academy’s program. I, being the parent/guardian of child(ren) listed above, consent to the student participation in any such tours or excursions arranged by Akiva Academy Daycare and Before & After School Care, and I authorize the participation by the student. It is understood that my consent and authorization is subject to advising me in writing of the following particulars of any tour or excursion at least three days prior to the intended date of the tour or excursion: 1. Destination; 2. Arranged supervision; 3. Date(s) and time(s); 4. Transportation plans; and 5. Costs, if any. I have the right to advise the Daycare and Before & After School care, by telephone, at least two days before the commencement of any particular tour or excursion, that I do not consent to the student participating in the tour or excursion, in which event my consent and authorization will be considered as withdrawn for the particular tour or excursion and the student shall not be allowed by the Daycare and Before & After School Care to participate in such tour or excursion. This consent and authorization will be in effect for the current school year only. No child will be permitted to be involved in any class trip until this form is returned to the Daycare and Before & After School Care.

______________________ Parent’s Signature

______________________ Parent’s Name (print)

__________________ Date

*one per child*

CHILDCARE LICENSING ACT requires a complete form Please use the checklist to ensure that the following has been attached          

Complete Application Form Applicable Legal Documents Postdated Cheques Immunization Records Allergies Emergency Contact Emergency/Medical Consent Media Release Form Annual Trip Authorization Form Policies and Procedures Review Initial:_________

COMPREHENSION OF POLICIES & PROCEDURES I understand and agree to abide by the policies and procedures outlined in the Policies and Procedures handbook/Parent Handbook/Faculty Handbook of Akiva Academy Daycare and/or Out of School Care programs. Do you have suggestions for our Policies and Procedures Handbook? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________ Parent’s Signature

______________________ Parent’s Name (print)

__________________ Date

______________________ Supervisor’s Title

______________________ Supervisor’s Signature

__________________ Date

To be used by the office only. Form checked by: _____________________________

Date: _________________________

Withdrawal: Last day in the centre: __________________________

Withdrawal by: _________________

Reason: _______________________________________________________________________ ______________________________________________________________________________