OSC Registration

Child Personal and Contact Information

Child's Name*

Date of Birth *

Gender*

Male Female

Home Address

Home Phone No.*

Child's School

Grade

School Address

School Phone

Start Time

End Time

Bus #

Bus Stop Location

Pick up Time

Drop off Time

If your child/ren require(s) transportation to and/or from their school, please advise a Director upon enrolment. If we provide service to your child's school, you will be provided with a transportation permission form which you will need to complete and sign PRIOR to any transportation being supplied for your child/ren by the centre.

Parent Personal and Contact Information

Parent 1

Name*

Address*

E-Mail Address*

Place of Work*

Work Address

Phones

Home

Cell*

Work

Allowed Access*

Yes No

Parent 2

Name*

Address*

E-Mail Address*

Place of Work*

Work Address

Phones

Home

Cell*

Work

Allowed Access*

Yes No

Relationship Status

Parents Relationship Status

Married Common-Law Divorced Separated Other

If other please explain

Emergency Contact Information

*An Emergency Contact person is someone OTHER than a parent*

Emergency Contact #1

Name*

Relationship to child*

Address*

Place of Work*

Work Address*

Phones

Home

Cell*

Work

Emergency Contact #2

Name

Relationship to child

Address

Place of Work

Work Address

Phones

Home

Cell

Work

Child Medical Information

Alberta Health Card Number*

Are Immunizations up-to-date*

Yes No

Physician Name

Physician Phone

Physician Address

List Any Allergies

Describe Reaction(s) if exposed to allergy

Explain Required Care if exposed to Allergy

List Any Other (non-allergy) Medical Conditions

Special Care… What we need to know

On-Going / Emergency Medications

For What Condition(s)?(including allergies)

Instructions & Dosage *a medication form must be filled out prior to centre administering any medication(s)*

The Following Named Are Allowed Access to My Child

Name

Relationship To Child

Name

Relationship To Child

Name

Relationship To Child

Name

Relationship To Child

Children will NOT be released to anyone who has not been authorized by the parent
A phone call from a parent to change/add an authorized person will be allowed only if the parent can answer security (personal and/or centre related) questions to confirm their identity
Anyone picking up a child must have authorization and government issued picture identification
Kildare Childcare & OSC reserves the right to refuse access to ANYONE who does not appear to be in a responsible condition

The Following Named Are NOT Allowed Access to My Child

Name

Relationship To Child

Name

Relationship To Child

Child Care Information

Has your child been in childcare before?*

Yes No

Day Home, Daycare or in the care of Family?*

Day Home Daycare Family Care

If previous Daycare, name of centre

Estimated Arrival Time at our centre

Estimated Departure Time from our centre

Tell us about your child

Tell us about your child

The reason we collect Family information is to help us get to know your child and their family. The more acquainted we are the better care we can provide. Additionally, we strive to provide a multicultural program and we believe this information may help us to enrich that programming.

Family Heritage

Where was the child born?*

Where was the child's mother born?*

Where was the child's father born?*

Child's First Language:

Other Languages:

What is the family's cultural heritage?*

Are there any faith based food or activity restrictions? If so please explain

Are there any faith based holidays/celebrations that you would like to see represented in our programming?

Is there anything you feel we should know regarding your family situation or personal beliefs? If so please explain

How would you describe your child's personality?

Is there any special thing that your child needs to go to sleep? (e.g. doll, Stuffy toy, blanket, etc.,)

Child's reaction when he/she is in stress

What are your child's favourite foods?*

What foods are refused?*

Please list again foods not permitted due to allergies/personal reasons

Describe your child's personality, disposition, likes and dislikes

Please describe any relevant events pertaining to your child's development that the centre needs to know about

What can we do to help support your child's development?

What can we do to help support your child's family?

The following sections require parent signatures to make the registration valid. Reading the Parent Handbook and our Policies & Procedures Manual is also required. If filling out the application on-line, your typed name will be accepted as your signature. Your signature is confirmation of your understanding and agreement of the information on the Registration Form, in the Parent Handbook and the Policies & Procedures Manual.

Parental Consent and Confirmation

Emergency Agreement
I/we give Kildare Childcare & OSC permission to take whatever steps are necessary to provide emergency medical treatment for my/our child as warranted. If an ambulance is required I/we understand that it will be at my/our expense.

Parent(s) Initials*

Date

Documentation Agreement
I/we give Kildare Childcare & OSC permission to take photographs of my/our child in their daily activities and post them on display in the centre. Photos will not be used for advertising, publication or telecast without explicit permission for that specific event.

Parent(s) Initials*

Date

Outdoor Policy
I/we give Kildare Childcare & OSC permission to take my/our child off the centre premises for neighbourhood walks, park outings and other such related activities while in the care of staff. For all other field trip outings, a permission form will be distributed and parent's signatures will be required for child participation.

Parent(s) Initials*

Date

Behaviour Policy
I/we understand Kildare Childcare & OSC aims to provide quality care for all children and families in a safe and comfortable environment. I/we understand that Kildare Childcare & OSC reserves the right to refuse or discontinue enrolment at their discretion should they feel my/our child poses a health or safety concern, displays unmanageable behaviour issues or is not suited for the program.

Parent(s) Initials*

Date

Parent Handbook & Policies and Procedure Manual Policy
I/we confirm that I/we have read and agree to the terms as laid out in the Parent Handbook and Policies & Procedures Manual. Further I/we understand that these rules and regulations are subject to change and I/we will be notified of any changes within a reasonable time. I/we will confirm in writing to adhere to the changes in order for my/our child/ren to continue to participate in the program.

Parent(s) Initials*

Date

Drop-Off and Late Pick Up Policy
I/ we confirm that child must be dropped-off no later than 10:00 AM and will be picked-up before 6:00 PM. A fee of $ 10 for first fifteen (15) minutes & then $ 5 per minute will be charged.

Parent(s) Initials*

Date

Registration Fees, Deposit and Monthly Fee Agreement
Registration Fees, Deposit and Monthly Fee Agreement I/we confirm to pay the Registration Fee ($100) to secure the spot for my child. Such fee is NON- REFUNDABLE I/we confirm to pay full month's fee regardless of sickness or holidays I/we understand that fees are due on or before first of every month. Failure to pay by first week of the month will result in $ 30 late pay and the child will not be accepted till all the fees have been fully paid. I/we confirm that in the event of Subsidy Application Refusal, the parents/guardians are obliged to pay the full amount of child care fees and services. I/we confirm that I/we understand that a minimum of 30 days WRITTEN notice of withdrawal provided DIRECTLY to the owners/directors is required or I/we are required to pay the next months fees in full. I/we understand that is my/our responsibility to keep my/our subsidy up-to-date. I/we further understand that if coverage is cancelled or suspended for any reason I/we are responsible for fees due in full. I/we confirm that if we have opted for part time daycare services, I/we need to pay the days opted regardless of holidays or sickness.

Parent(s) Initials*

Date

Sunscreen and Insect Repellent Application Agreement
I/we give permission to Kildare Childcare & OSC Staff to apply Sunscreen and Insect Repellant spray that I/we provided. These skin Protection agents are labelled with my child's name and expiry date; and are in their original packaging. In the occurrence of any allergic reaction, I will be notified immediately, and the staff will discontinue using these products.

Parent(s) Initials*

Date

Print Parent Name(s)

Parent Signature(s)

Health Care and Essential Items

Emergency Agreement
The Parents are expected to provide the following essential items:

One extra clothing for emergency use (labelled with child's name)
One inside and outside shoes- weather appropriate (labelled with child's name)
Water bottle (labelled with child's name)
In Summers: Hat, Glasses, Sunscreen & Bug Spray
In Winters: S now Pants, Snow Jackets, Mittens & Winter Cap

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OSC Registration

Program: 6 to 12 years

Tell us about your child