carselandbeforeandafter@gmail.com
|
403-901-5008
Carseland Before and After Program
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
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
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
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
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
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
Daily Absence Policy
I agree to contact the Carseland Before and After Program when my child will be absent from the program on his or her scheduled day. I understand that doing so allows the program to regulate numbers and prioritize staff. I also understand that this allows an opening for other families on the waiting list to attend the program.
Drop off or Pick up Policy
I agree to contact the Carseland Before and After Program when my child will be arriving 30 minutes or more past their regular drop off time. I agree to contact the before and after program if any persons other than myself or other legal parent/ guardian is dropping off or picking up my child. I agree to contact the program when my chid is being picked up from school early and therefore will not be attending the after school part of the program. I understand that this is a separate phone call or email made to the program than from the courtesy call made to Carseland School. I understand that the program closes at 6pm and that I need to contact them if I know I will be late or if any other persons are picking up my child. I understand that if my child is still in attendance 10 minutes after the program ends, a $1 per minute charge will be added to my fee until an authorized pick up person arrives.
Punch card Policy
I have purchased a Carseland Before and After Program punch card for my child, before attending the program I agree to: - contact the program to enter my child's scheduled attendance days. - contact the program when my child will not be attending their scheduled punch card days. I understand that failure to schedule days before attending may result in the program tuning us away. I understand that once my child's scheduled days are reported, the program will expect us on those days. I understand that failure to contact the program about my child's absence on scheduled days will result in a regular attendance punch on my Childs card. I understand that once a punch card is full a new punch card must be purchased before my child can attend again, if needed.
Photos Inside the Centre
I hereby consent to and authorize Carseland Before and After Program to use and reproduce photographs taken of my child to post inside the centre.
Photos for Online Media
I hereby consent to and authorize Carseland Before and After Program to use and reproduce photographs taken of my child to use for display on our website and any online social media platform. Written consent can be revoked at any time by contacting the Before and After Program.
Medical Authorization
In the event that I can not be reached and emergency medical or first aid treatment is required for my child, I hereby agree to allow the Director or staff of Carseland Before and After Program to seek or administer any medical treatment appropriate. I agree to be responsible for any costs incurred as a result of this medical treatment.
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.
Wrap up
How did you first hear about us?
Web Search
Word of Mouth (referral)
Drive by (saw the signs)
Other
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