seedsandsprouts1@gmail.com
|
780-737-5510
Seeds & Sprouts ELCC
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
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
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
Daycare
Out of School Care
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
Daycare
Out of School Care
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
Daycare
Out of School Care
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
Illness Policy
Details regarding the illness policy are found in the Parent Handbook. I understand that Seeds & Sprouts ELCC follows the guidelines set out by Alberta Health, and that my child is not to be in attendance if they have any of the symptoms listed in the policy. They may return to the program when the requirements set out in the policy have been met.
Topical Lotions / Diaper Cream
I authorize Seeds & Sprouts to apply lotion and/or diaper cream and/or lip chap (all listed are provided by the parents) on my child as required.
Parent Handbook
I have read, understand and agree to the terms , rules and guidelines included in the Parent Handbook.
Termination Agreement
I understand I must provide 30 fiscal days notice in writing, if I wish to terminate my child's spot at Seeds & Sprouts ELCC. If I do not give one fiscal month's notice that I would be responsible for paying for the following month.I understand that in excess of one month of my childcare fees being paid - I risk termination of my spot and my account going to a third party collection agency.
Hours of Care Agreement
I understand that my child will need to be at Seeds & Sprouts no later than 9:30am (unless alternative arrangements have been made), and that they must be picked up by 5:45 pm . If I arrive after this time there may be a late pick-up fee charged to my account. Children are not to attend the program for longer than 10 hours a day.
Sunscreen
I hereby authorize Seeds & Sprouts ELCC staff to apply sunscreen (provided by parents) on my child in spring and summer as needed.
Insect Repellent
I hereby authorize Seeds & Sprouts ELCC staff to apply insect repellent (provided by parents) on my child in spring and summer as needed.
Photos Inside the Centre
I hereby consent to and authorize Seeds & Sprouts ELCC to use and reproduce photographs taken of my child to post inside the centre.
Photos for Online Media
I hereby consent to and authorize Seeds & Sprouts ELCC to use and reproduce photographs taken of my child to use for display on our website and any online social media platform.
Neighbourhood Walks
I understand that walks to neighborhood areas and parks are part of the programming at Seeds & Sprouts ELCC and I hereby give consent for my child to participate in these activities, without additional notifications for such walks. Seeds & Sprouts has a 20 block walking radius.
Medical Authorization
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 Seeds & Sprouts ELCC 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 Seeds & Sprouts ELCC to aid in / provide transportation for my child to and from school. I understand that I am bound by the transportation agreement that is provided to me at the beginning of each school year.
Telephone number / email release
Other parents sometimes request a family's phone number/email 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/email for this purpose.
Wrap up
How did you first hear about us?
Print Directory
Alberta Government Website
Web Search
Word of Mouth (referral)
Drive by (saw the signs)
Other
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