famida@optionsacademy.ca
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780-278-7491
Options Academy
Online Registration
Family
Family Name
First Parent
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
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CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
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NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Work Name
Work Phone
Work Address
Birthdate
Email Address
By providing your email address you are implying consent to receive occassional email messages from our centre
Second Parent
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Work Name
Work Phone
Work Address
Birthdate
Email Address
By providing your email address you are implying consent to receive occassional email messages from our centre
First Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
School
Please enter school details as you expect them to be on your child's start date
Not in school
Attending kindergarten
Attending grade 1 to 6
School Name
Enrolment
Desired Start Date
Program
Full Day Academy
ASC
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Second Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
School
Please enter school details as you expect them to be on your child's start date
Not in school
Attending kindergarten
Attending grade 1 to 6
School Name
Enrolment
Desired Start Date
Program
Full Day Academy
ASC
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Third Child
Given Name
Last Name
Goes By
Birthdate
Sex
Male
Female
Living Arrangements
Child lives with
Mother
Father
Other
Other Guardian
Is there a custody agreement?
No
Yes
Custody Agreement Notes
School
Please enter school details as you expect them to be on your child's start date
Not in school
Attending kindergarten
Attending grade 1 to 6
School Name
Enrolment
Desired Start Date
Program
Full Day Academy
ASC
Frequency
Full Time
Part Time
Drop In
Hours
Days
Weeks
Months
per Hour
per Day
per Week
per Month
per Term
per Quarter
per Year
Medical
Health Care #
Physician's Name
Physician's Phone
Diet Restrictions
Allergies
Other Medical Concerns
Is your child's immunization up to date?
No
Yes
Does your child receive medication on an ongoing basis?
No
Yes
Medication Details
Subsidy
Subsidy is approved
Amount Approved
I have applied for subsidy
Application Date
I will apply for subsidy
I need help applying for subsidy
I do not plan to apply for subsidy
Other questions, comments or notes
Emergency Contacts
(Other than parents)
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Authorized for Pickup
Relation to Child
First Name
Last Name
Cell Phone
Home Phone
Address
City
Province
AB
BC
MB
NB
NL
NT
NS
NU
PE
SK
ON
QC
YT
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Postal Code
Authorized for Pickup
Agreements
School Pick-Up / Drop-Off
I authorize Options Academy to Pick-Up and / or Drop-Off my child to _____________________________ school on school days as required. I understand that Options Academy staff will be responsible to drop my child off on the school premises no more than 10 minutes prior to the first school bell and will not be responsible for staying on the school premises until my child goes into the school I also understand that Options Academy staff will meet my child at a pre-determined location after school for pick-up. In the event that my child is not at the pick-up location within 10 minutes after the end of school, staff will try to reach me by phone. In the event that staff is unable to reach me and my child is still not there 15 minutes after the end of school, I understand that Options Academy staff will contact the police and report a missing child.
Sunscreen Application
I hereby authorize Options Academy staff to apply sunscreen (provided by parents) on my child in spring and summer as needed.
Insect Repellent Application
I hereby authorize Options Academy staff to apply insect repellent (provided by parents) on my child in spring and summer as needed.
Photographic Release
I hereby consent to and authorize Options Academy to use and reproduce photographs taken of my child to circulate same for advertising and display purposes of every description
Field Trips & Neighbourhood Walks
I understand that field trips and walks to neighbourhood areas and parks are part of the programming at Options Academy and that these walks will take place within a 1km radius from Options. I hereby give consent for my child to participate in these activities.
Medical Authorization
I hereby agree to allow the Director or staff of Options Academy to administer any medication to my child that I have provided to Options Academy. I understand that Options academy will only administer medication that is provided in the original labelled container and the medication will be administered according to the labelled directions. In addition, in the event that I can not be reached and emergency medical treatment is required for my child, I hereby agree to allow the Director or staff of Options Academy to seek any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
Transportation to and from School
I hereby consent and authorize Options Academy to walk my child to/from school, supervised by the Director and/or staff of Options Academy.
Telephone Number Release
Other parents sometimes request a family's phone number so they can phone to invite your child to a birthday party or some other social event. Please sign below if you have no objections to the release of your phone number for this purpose.
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