FOR OFFICE USE ONLY (Circle) Registered In: M Tu W Th F S

WALDEN

AM PM

3

4

2014/2015 Preschool Registration

OFFICE USE ONLY

Date of Registration: ________________ Date of Admission:______________ Date of Withdrawal: ______________ Post Dates:_____________________ Registration Fee Paid (Non-Refundable): ________________



Three & Four Year Old Classes (3 hour sessions)

Tues/Thurs (3 hour) Jr. Preschool (3 yr olds) $223 Tues/Thurs (3 hour) Jr. & Sr. Preschool Combined (3 & 4 yr olds) $298 Mon/Wed/Fri (3 hour) Jr. Preschool (3yr olds) $298 Mon/Wed/Fri (3 hour) Jr. & Sr. Preschool Combined (3 & 4yr olds) $223

$475

Mon/Tue/Wed/Thurs/Fri

$125 $125

Saturdays (Silverado Only)

AM

9:00 - 12:00

PM

12:35 - 3:35

AM

8:50 - 11:50

PM

3/4

12:25 - 3:25

Four-Year Old Classes (3 hour sessions) Tues/Thurs Sr. Preschool (4yr olds) Tues/Thurs Sr. Preschool (4yr olds) Mon/Wed/Fri Jr. Kindergarten (4yr olds) Mon/Wed/Fri Jr. Kindergarten (4yr olds)

Five AM or PM sessions

Mon/Tue/Wed/Thurs/Fri

10:00 – 1:00

Saturdays (Walden Only)

AM

8:50 – 11:50

 $223 $223

PM

12:25 – 3:25

AM

9:00 – 12:00

$298 $298

PM

12:35 – 3:35 Five AM or PM sessions

$475

9:30 – 12:30

$125

3/4

PRICES ARE BASED ON A YEARLY FEE DIVIDED INTO TEN EQUAL MONTHLY PAYMENTS How did you hear about us? ___________________________________________________________________ **Please fill all out all sections of this package** Legal Surname of Child _________________ Date of Birth (M/D/Y) Child’s first language

First Name _________________ Gender (Circle) Male

Female

Child’s second language

Address (Place of Residence)

Mailing Address (if different from above)

Home Phone EMAIL ADDRESS FOR MAIN COMMUNICATION FROM SCHOOL ______________________________________________ ***Please print carefully as this is the main form of communication. Please also remember to add us to your safe sender’s list as we often end up in the junk mail.

Parent/Guardian

Cell Phone ________________

Address/Home Phone (if different from above)________________________________________ ______________________________________________________________________________ Work Address and Phone: ______________________________ Email Address Parent/Guardian

Cell Phone

Address/Home Phone (if different from above)________________________________________ ______________________________________________________________________________ Work Address and Phone: ________________________________________________________ _____________________________________________________ Email Address Please tell us a little about your child? How many siblings does your child have? What are their names? _____________________________________ Do you have a pet at home? _________________________________________ What is their favourite type of activity? __________________________________________________________ Have you noticed any difficulties with pronunciation of certain sounds? ____________________________________________________________________________________________________ ________________________________________________________________________________ Is there anything else you would like to tell us about your child? ________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________

Caregiver Information (Special Needs Child) If your child will be cared for by a caregiver during school hours, in our facility, please provide the Name _______________________________________________Phone number _____________________ This person must also have a police clearance check done prior to first day of school.

Does your child have any of the following?: Special needs (please state medical diagnosis and treatment as well as any Individual Program Plan and agencies involved): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Medical Information

Alberta Health Care Number ________________________

Doctor’s Name _________________________Doctor’s Phone Number ____________________ Immunizations up-to-date as per Alberta Health’s Schedule (please circle): Allergies (please circle):

YES

NO

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, please fill out the Medication Consent form included in this package.

EMERGENY CONTACTS: This information is duplicated on the Portable record because it has to be kept in two different places in the school (in the office, in your child’s main file and in the emergency backpack for when we are outside of the school. There must be 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:

PORTABLE RECORD FILE

Session _______________________________

It is important to fill this file out completely as it is the record taken with us when we leave the preschool for walks, fun at the park, field trips 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. Thank you. 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:

Leap n’ Learn Fees and Cancellation Policies Temporary absences (however long), such as a vacation or illness, are not deducted from monthly fees. Payment is still expected in full. If a child is to be withdrawn permanently from the school, one month's written notice is required and the tuition fees following the months notice will be destroyed. The 75.00 registration fee is non-refundable. * Monthly fee option: post dated cheques for the duration of enrolment due upon confirmation of registration. Cheques are to be dated for August 1st, 2013 (1/2 month fee), September 1st, 2013 (1/2 month fee) and October to June (full month fees). If paying in full, payment of full fees are due by August 15th or ½ fees on August 1st and September 1st 2013. When paying in full, 50.00 of the registration fee will be deducted from your payment in August. * $25.00 fee for all NSF cheques * Late pick-up fee: $1.00 per minute will be charged if more than five minutes late as the school has to pay the teachers to stay with your child until they are picked up. Thank you for your understanding and for being on time. Leap n’ Learn Child Care 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 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 fully trained in child development and how it relates to guidance (discipline) and the positive guidance strategies we will list below.  Clear guidelines are provided so that children know what is expected of them. Limits that relate to safety and protection of self, others, and the environment are clear and are enforced consistently in a positive way. Children are given time to respond to expectations.  Each child will be respected as an individual and each incident will be treated as an individual situation.  Caregivers may use a variety of strategies depending on the child and the situation. These strategies include: positive reinforcement of appropriate behaviour, gaining a child’s attention, staying in close proximity to the child, reminding, acknowledging feelings before setting limits, redirecting or diverting, age appropriate choices, and natural consequences.  All children will be treated with respect. Children will not be disciplined in a punitive manner.  Our goal is to encourage children to develop respect, self-control, self-confidence, and sensitivity in their social interactions during their time at preschool. Date of enrolment

/

/

Date of discharge

/

/___

Signature of Parent/Guardian

_

Signature of Parent/Guardian

_

Signature of Supervisor OFFICE NOTES _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________

AUTHORIZATION FOR PICK-UP Please provide the names of anyone who will be responsible for picking up your child, including parents/guardians. All authorized persons must be 18 years of age or older, unless otherwise designated by written parental consent. Under no circumstances will any child be released to anyone without written authorization from a parent or guardian. Anyone on this list must also show picture I.D. or a Leap n’ Learn Pick Up Pass at the time of pick-up. The following is a list of people authorized to pick up ____________________________________: (Child’s Full Name)

Name of person: ___________________________ Address: ___________________________________________________________________ Relationship to child: _________________________________________________________ Home Telephone: _____________________ Cell Phone: __________________________

Work Telephone: _____________________ Other Phone: ________________________

When can this person pick up your child? _________________________________________ Name of person: ___________________________ Address: ___________________________________________________________________ Relationship to child: _________________________________________________________ Home Telephone: _____________________ Cell Phone: __________________________

Work Telephone: _____________________ Other Phone: ________________________

When can this person pick up your child? _________________________________________ Name of person: ___________________________ Address: ___________________________________________________________________ Relationship to child: _________________________________________________________ Home Telephone: _____________________ Cell Phone: __________________________

Work Telephone: _____________________ Other Phone: ________________________

When can this person pick up your child? _________________________________________ Name of person: ___________________________ Address: ___________________________________________________________________ Relationship to child: _________________________________________________________ Home Telephone: _____________________ Cell Phone: __________________________

Work Telephone: _____________________ Other Phone: ________________________

When can this person pick up your child? _________________________________________ Parent Signature ______________________________

Date: ___________________________

PARTICIPATION & OFF PREMISIES CONSENT FORM

Child’s Name

Surname

First

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 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. All outings are within walking distance. No transportation will be necessary. 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.

SIGNATURES PARENT OR GUARDIAN

Date ___________

PARENT OR GUARDIAN

Date ___________

Emergency Release: Consent to Emergency First Aid & Transportation: In all situations, every effort will be made to contact the parent. However, the well-being and comfort of the child will be the first priority. I hereby give permission that my child, _________________________, may be given emergency treatment by a staff member certified in First Aid at Leap n’ Learn Preschool Inc. I also give permission for my child to be transported by ambulance, to an emergency center for treatment, 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 enrollment or any time thereafter. ____________________________________Date:______________________ Parent or Guardian Signature ____________________________________Date:______________________ Parent or Guardian Signature

MEDIA CONSENT FORM 2014/2015

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 and Leap n’ Learn Parent Newsletter (distributed to Leap n’ Learn families only). The newsletter, if published to the website will have no pictures of children. I also consent to my child’s WORK being published on the Leap n’ Learn website (no photos or last names of children will be published on the website). By law, Leap n' Learn Preschool protects the privacy of the students and is prohibited from releasing students’ personal information. Any student and/or their school work will be identified by first name only. No last names will be mentioned. All children`s work will be published within the Leap n’ Learn Preschool from time to time. Please Print

Student’s Name: ________________________________________________________________________ Address: ________________________________________________________________________ City: ____________________________ Prov: _________ PC: _____________ Signatures Parent or Guardian ____________________________________________ Parent or Guardian ____________________________________________ _____________________________________________________________

I would like my child’s name, email and house phone number distributed to their classroom friends to arrange play dates, birthday parties and other events. This will be put together by the classroom teacher in October. This list is only shared with classmates in your child’s session.

Yes

Student’s first and last name : __________________________ email: __________________________ Phone Number: ________________________

No

MEDICATION ADMINISTRATION AND CONSENT FORM TO BE COMPLETED IN INK ONLY and only for emergency medication. Please do not complete unless required.

Child’s name

__________________

Medication

__________________

Dosage

__________________

I ____________________________ give permission for ________________________________________ (write specific dosage ie 1.5ml and name of meds) to be administered to ______________________ from __________(month/year) _____________ (month/year). Parent Signature __________________________ Signs & Symptoms Indicating an Allergic Reaction Requiring Medication

Special Instructions (e.g. to be taken with food)

__________________

__________________

Other

__________________

Please Read Carefully: CONSENT I hereby consent to the administration of the above Medication to my child, _______________________, by the caregivers of Leap n’ Learn Preschool Inc. in the event that he/she shows any of the signs & symptoms indicating an allergic reaction requiring Medication which are listed above. Signatures and any additional DETAILED INSTRUCTIONS: ______

_______

_____________________ ______ ________________________________________________________________________

Parent or Guardian Signature

Date

Staff Receiving

Date

Continued  Time

Dosage

Date

Staff’s Signature

I, ________________________________________, have read and understood all policies and procedures implemented at Leap n’ Learn Preschool Inc.

The Directors of the centre have the right to terminate service if failure to comply with these policies occurs.

________________________________________ (Parent or Guardian Signature)

________________________________________ (Parent or Guardian Signature)

_________________________ (Date)

_________________________ (Date)