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SILVERADO

2014 Before n’ After School

CHILD INFORMATION

Legal Surname of Child _________________ Date of Birth (M/D/Y)

First Name _________________ Gender: Male

Female

ALBERTA HEALTH CARE #

School Attended

Grade 2014/2015

Immunizations up to date: YES NO / Doctors Name & Number

/

ALLERGIES/MEDICAL NEEDS (fill out additional info on next page) Address (Place of Residence) Postal Code Mailing Address (if different from above) Please select the appropriate program: Prices are per month:

KINDERCARE (710.00) _____ Before & After (400.00) _____ Before Only _____ After Only _____ Drop In _____

PARENT INFORMATION: Please put parent living with child in #1 slot if families live at different addresses. Parent/Guardian 1

Cell Phone ________________

Work Address ______________________________ Work Phone Number

Email Address

Parent/Guardian 2

Cell Phone

Home Phone Number (if different from child’s)

Email Address

Address (if different from child’s)________________________________________ Postal Code _________________________________ Work Address _______________________________________________ Work Phone Number Are both parents/guardians authorized to pick up your child?

Yes____ No____ If not, please provide any necessary

additional information

EMERGENCY CONTACT: (MUST be someone other than the parents or guardians mentioned above and will be called in the order you list them). FULL ADDRESS AND AT LEAST ONE CONTACT NUMBER MUST BE PROVIDED. You must provide at least one emergency contact. Contact Person #1

Home Phone:

Home Address: (must be a legal land description if in a rural area – no box #’s or RR #’s)

Work Phone:

City:

Cell Phone:

Postal Code:

Contact Person #2

Home Phone:

Home Address: (must be a legal land description if in a rural area – no box #’s or RR #’s)

Work Phone:

City:

Cell Phone:

Postal Code:

Are the people above authorized to pick up your child? Person #1 _____ Yes _____No

Person #2 ____ Yes ____No

Registration Checklist: Completed Registration ____ $50.00 Registration FEE ____ General Consent Form ____ Signed Guidance and Behaviour Policy ____

Post Dated Cheques ____

Allergies (please circle):

YES

NO

If yes, please indicate ______

How do the allergies manifest themselves?

______________________________________________________________________________

______

Medical Conditions Medications taken at home on a regular basis If your child has a medication that is taken on a regular basis or for emergency purposes, you will need to fill out a medical consent form. We can provide one for you at the school or email it to you directly to be filled out and handed in with your registration package. Is there anything else we should know about your child? ______________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

LEAP N’ LEARN CHILD CARE DISCIPLINE & AGGRESSIVE BEHAVIOUR POLICY DISCIPLINE POLICY: At Leap n Learn we respect each child and his or her level of development, individual personality, and their family and cultural influences. We use positive guidance and create a positive environment (plenty of toys, activities, space, as well as area boundaries to divide activities) so as to influence positive behaviour. The caregivers are trained in child development and how it relates to guidance (discipline). Please see our Parent Handbook for more comprehensive guidelines and strategies. DEALING WITH AGGRESSIVE BEHAVIOUR: We believe it is essential for children to behave with respect for themselves, other children, adults and the equipment at Leap n’ Learn. When a child is physically or verbally aggressive, or if they endanger themselves or another child, or behave abusively towards the Leap n’ Learn staff, the facility or equipment, he or she will be removed immediately from the area and asked to sit and have a “body break” until he or she calms down. Once the child is calm, the problem will be identified and discussed with the child. If a child is continually aggressive in his or her behaviour, he or she will be removed from certain activities for the entire period and given an individual, quiet activity to do. If behaviour continues at this point, parents will be called to pick up child at the school and to schedule a meeting with the director. The behaviour will be discussed with parents and at that time, the parents, leader/director will try to set up a plan of action to implement for both home and Leap n’ Learn. The Director will work with the parents and bring in support if they feel it is necessary. Leap n’ Learn Directors reserve the right to terminate or suspend a child’s care should the behaviour continue to pose a Health or Safety concern to staff, peers or be disruptive to the program. SIGNED:

NAME PRINTED: (Parent or Guardian Signature)

DATE:

(m/d/y)

Preschool inc.

General Consent Form

I, the parent and/or guardian of ________________________________, hereby give permission, approval and consent to the following:

Emergency health care or first-aid to be administered by a staff member certified in First Aid at

Leap n’ Learn Preschool inc. and/or use of 911 services should he/she suffer an injury or serious illness while in the care of Leap n’ Learn and agree to hold Leap n’ Learn Preschool Inc. and its employees and directors harmless. Leap n’ Learn Preschool inc. will not be responsible for any incident that may occur as a result of false, misleading or missed information that is given or omitted at the time of enrolment or any time thereafter. I also agree to be responsible for costs associated with emergency medical services.

I have read and agreed to the policies outlined in the Leap n’ Learn Parent Handbook. The above named child has my permission to participate in activities in the Leap n’ Learn Preschool Inc. facilities. The above named child also has my permission to leave the Preschool centre premises under the supervision of our staff for community shopping centre field trips, nature walks, outings to community playground, road safety awareness activities and lessons. I hereby give permission for the above named child to take part in outings, supervised by the staff of Leap n’ Learn Preschool inc. and are within walking distance. I understand that ADDITIONAL parental consent forms will be issued when the excursions involve the use of chartered school buses.

I hereby, on behalf of my child, myself, our successors and assigns, release and discharge Leap n’

Learn Preschool Inc., its directors and staff or parent volunteers from any and all claims, actions and causes of action arising from any accident or loss caused by the participation of the child named during any activity held at this location, or any location where the program is held or on route to any such activity.

I understand that it is my responsibility to make alternate child care arrangements if my child is not participating in an off-site activity.

I understand that fees are payable in full by the first day of each month, and that child care can be terminated at any time if my fees are in arrears.

Temporary absences, such as a vacation or illness, will not be deducted from the monthly fees. A minimum one (1) month written notice of withdrawal is required on or before the 1st of the month

prior to the month leaving, whereupon your remaining post-dated cheques following the notice will be destroyed. For example, if you are withdrawing November 18th, notice must be given on or before October 1st, not October 18th. We do not prorate the monthly fees for withdrawals.

I hereby consent to the use of any photographs, video tape or audio record taken of my child by Leap n'

Learn Preschool Inc. to be used within the Leap n’ Learn classroom. Any student and/or their school work will be identified by first name only. No last names will be mentioned. I also consent to my child’s WORK being published within the classroom & the Leap n’ Learn Website. Leap n’ Learn Preschool Inc. will ALWAYS protect the privacy of the students.

Name (Signed): __________________________ (Parent or Guardian Signature) Date: ______________________ (M/D/Y)

Name (Print)

PORTABLE RECORD FILE

School

Before / After / Kinder

It is important to fill this file out completely as it is the record taken with us when we leave the school for walks, outings to local businesses, fun at the park, field trips, walking to and from school bus stop or in the case of an emergency such as an evacuation. Please make sure that this file is kept up to date with the preschool. Report any changes immediately. Child’s information: Full Name:

Birthdate: Month/Day/Year ____/____/____

Physical Address:

City:

Alberta Health Care Number:

Immunizations up-to-date:

Postal Code: YES _____ NO _____

Health Concerns/Allergies/Medication

Parent’s Information: Mother’s Name:

Mom’s Cell Phone:

Home Address:

Home Phone:

City:

Postal Code:

Work Phone:

Father’s Name:

Dad’s Cell Phone:

Home Address:

Home Phone:

City:

Postal Code:

Work Phone:

Emergency Contacts: (MUST be someone other than the parents or guardians mentioned above and will be called in the order you list them. YOU MUST LIST AT LEAST ONE EMERGENCY CONTACT) Contact Person #1

Home Phone:

Home Address: (must be a legal land description if in a rural area – no box #’s or RR #’s)

Work Phone:

City:

Cell Phone:

Postal Code:

Contact Person #2

Home Phone:

Home Address: (must be a legal land description if in a rural area – no box #’s or RR #’s)

Work Phone:

City:

Cell Phone:

Postal Code:

Contact Person #3

Home Phone:

Home Address: (must be a legal land description if in a rural area – no box #’s or RR #’s)

Work Phone:

City:

Cell Phone:

Postal Code: