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FORMS

At Glengarry Child Care Society, we greatly value your child. That is why we believe in providing the means for excellent early childhood education, including a first-class environment to cater to the growing needs of children. Fill out the forms given below to enroll your child or call us to learn more.

CHILD ENROLLMENT FORM

CHILD INFORMATION

Program (Please Circle One):

Date of Enrollment:

Child’s Name:

Child’s Date of Birth:

School Attended (if applicable)

Hours of Care Required:

Reason For Care:

Child Resides With (please circle one):

Custody Agreement (circle one):

If Yes, provide details of the agreement:

Others in the household and relationship:

MEDICAL INFORMATION

Alberta Health Care Number:

Immunization Records current and up to date (circle one):

(A copy of your child's Alberta Health Care Card and Immunization Records are required.)

In the event of a medical emergency and I/We cannot be reached, I/We

hereby authorize Glengarry Child Care Society to obtain medical treatment for my child,

from my doctor or any other physician selected by the center.

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1

Name:

Address:

Postal Code:

Home Phone #:

Cell Phone #:

Email:

Employer Name:

Occupation:

Employer Address:

Work Phone:

Parent/Guardian 2

Name:

Address:

Postal Code:

Home Phone #:

Cell Phone #:

Email:

Employer Name:

Occupation:

Employer Address:

Work Phone:

INDIVIDUALS AUTHORIZED TO PICK UP THE CHILD

NAME

RELATIONSHIP

NAME

RELATIONSHIP

NAME

RELATIONSHIP

NAME

RELATIONSHIP

NAME

RELATIONSHIP

NAME

RELATIONSHIP

NAME

RELATIONSHIP

EMERGENCY CONTACTS (all information MUST be completed)

Name:

Name:

Relationship:

Relationship:

Address:

Address:

Postal Code:

Postal Code:

Home Phone:

Home Phone:

Cell Phone:

Cell Phone:

Work Phone:

Work Phone:

HEALTH INFORMATION

Please answer the following questions regarding your child’s health and medical history

Does your child have any physical disabilities (please circle)?

If yes, please describe

Does your child have any chronic health problems such as Asthma, Allergies, Diabetes, Convulsions, etc. (please circle)?

If yes, please describe

What is the reaction?

Procedure to follow if a reaction occurs?

3. Does your child take medication regularly? If yes, please list:

Name of medication:

Dosage:

Time:

Name of medication:

Dosage:

Time:

4. Does your child have any special dietary restrictions?

If yes, please list:

5. How does your child react to minor injuries (bumps, scrapes)? What comforts him/her?

CHILD INTAKE FORM

GLENGARRY EARLY LEARNING AND OUT-OF-SCHOOL CARE

***Please complete all areas of this form***

When do you need care to start?

Child’s Name

Child’s Date of Birth:

Parent/Guardian:

Address:

City:

Phone #:

Alternate Phone #:

Email Address:

What School does your child attend (if applicable):

What hours of care do you require?

Does your child have any significant health conditions that we should be aware of?

Does your child have any exceptional needs? (wheelchair, developmental delay, behavioral)

Thank you for providing this information, we will be in contact with you in the next few days.

GLENGARRY FAMILY DAY HOMES

***(please complete all areas of this form***

When do you need care to start?

Child’s Name:

Birthdate:

Parent/Guardian:

Address:

City:

Phone #:

Alternate Phone #:

Email:

Do you require the Day Home to be close to your home?

Do you require the Day Home to be on a bus route?

Are pets in the home okay?

Do you require a non-smoking home? (smoking is not permitted in the Day Home):

What hours of care do you require?

Do you require care before 6:00 a.m., after 6:00 p.m. or on weekends?

Are you looking for a home that speaks a language other than English?

If yes, please indicate the preferred language:

Does you child have any significant health conditions that we should be aware of?

Does you child have any exceptional needs? (wheelchair, developmental delay, behavioral)

Thank you for providing this information, we will be in contact with you in the next few days

FAMILY PROFILE

Parent’s Name(s):

Child/ren’s Name(s):

What is the primary cultural background of your family?

What other cultural backgrounds make up your family?

Do you speak a second language? If so, what language?

Would you be willing to share a couple of simple words to the staff and children?

Word:

Meaning:

Word:

Meaning:

If you have one, could you share a family recipe so the children can experience foods from different cultures?

Name of recipe:

Ingredients:

What cultural celebrations does your family take part in?

Please note other celebrations below:

Do you, or a family member, have a special skill or talent that could be shared with the children?

If yes, what is that skill or talent?

Do you have family heirlooms or other artifacts from your culture that you would be willing to share with the children during circle time?

(We would request them at some point during your child’s stay with us to share)

Do you have any community connections to different cultural groups that would be willing to come into the centre and demonstrate their skill or talent for the children?

Name of organization:

Contact Name:

Contact Number:

Glengarry Child Care Society wants to ensure that your family and its history become a part of our programming with our children. We appreciate your contribution to celebrating diversity with us!

Thank you for taking the time to complete this form.

PRE-AUTHORIZED DEBIT (PAD) AGREEMENT

GCCS Account #: (do not complete, this will be automatically generated)

Name:

Street Address:

City:

Province:

Postal Code:

Telephone: Home:

Work/School:

Cell:

Email Address:

Bank Account Information (or attach a VOID cheque)

Account #

Branch Transit # (5 digits)

Financial Institution # (3 digits):

Chequing Account

Savings Account

Financial Institution: Name:

Branch Address:

Payment Details

Full Fee:

Affordability Grant:

Subsidy:

Total Payment

I, the Payor, authorize GCCS to debit the bank account identified above for payment of childcare fees in the amount of $

as indicated below

Date (Please check one)

I agree that the amount of my monthly withdrawal can be changed by GCCS as necessary. I understand that I may request copies of any PAD payments by contacting the Executive Director of GCCS

Signature of Account Holder

Signature of Joint Account Holder (if applicable)

Name (please print)

Name (please print)

Date

Date

PARENT – AGENCY AGREEMENT

In admission of my child(ren)

to Glengarry Child Care Society, I

agree to the contents of this agreement and to comply with the policies and procedures as outlined in the Parent Policy Manual

I have received a copy of the Parent Policy Manual and understand that it is my responsibility to review its contents and direct any questions or concerns to the Executive Director or the Program Supervisor

Fee Schedule

Fee Schedule - Effective January 1, 2022 (The fulltime fee includes the Affordability Grant)

A non-refundable registration fee of $50.00 must be paid before a space is confirmed. Once the registration fee has been paid, it will not be refunded under any circumstances.

Monthly fees are paid by PAD (Pre-Authorized Debit) only. Withdrawal dates are the last business day of the previous month or the 21st of the current month. There will be no refunds given for absent days from the program due to Statutory Holidays, personal vacation or illness.

A refundable space deposit is required at the time of registration as per the table below. Space deposits are refunded or applied to the final month of care, providing adequate notice of termination is given. Space deposits will be refunded within 1 month after the final day of care. The space deposit can be paid in installments of no less than $50.00/month by signing a payment agreement

In the case of extended absences of more than 30 days, the full unsubsidized monthly fee must be paid in advance in order to retain the child’s space. The affordability grant and subsidy will not be paid if the child does not have attendance hours. If payment is not received prior to commencement of the leave, the child’s space will be terminated and filled with a family from the waiting list.

One month’s written notice is required when terminating care. Notice can only be given on the 1st business day of the month. If less than one month’s written notice is given, the space deposit will be retained by the Society.

Parent’s arriving after 6:00 p.m. will be charged a late pick up fee of $25.00 for the first 10 minutes and $1.00/subsequent minute after 6:00 p.m.. The Eduators will make every effort to contact the parents and/or emergency contacts. If contact cannot be made by 8:00 p.m., the Crisis Line will be contacted and the child will be placed in their care.

Educators must be made aware when the children are dropped off and picked up from the centre. The parent must ensure that they contact an Educator when dropping off and picking up their child. It is the Educators responsibility to sign the children in and out on the HiMama system, using the computers in the rooms

The centre will not release the children to anyone unless authorization has been given by the parent. It is the parent’s responsibility to notify the centre if someone other than themselves will be picking up their child. Parents will be required to provide a family password that will be used to verify any individual arriving at the centre to pick up a child that is not known to the Educators.

Family Password:

Fundraising revenue is an important part of the Society’s annual operating budget. A payment of $19.25/month/family has been implemented to eliminate the need to run fundraising events. All families are required to pay this monthly fee. No further participation in fundraising will be required.

Glengarry Child Care Society reserves the right to access medical assistance for any child left in our care, when it is deemed such assistance necessary, 9-1-1 will be called and the the child will be transported to the Northeast Community Health Centre, 14007 – 50 Street, or as decided on by EMS. The parent or emergency contact contacted, informed of the situation and given the ambulance destinate. The Executive Director or Program Supervisor will accompany the child to the Hospital and wait for the parent to arrive. All costs incurred with accessing medical assistance are the parent’s responsibility.

Glengarry Child Care Society agrees to use all due care in caring for all children and their effects; however, the Society is not liable for any loss of, or damage to, clothing or other effects of children, not for any accident, injury, illness or disease that may occur to any child while in the care of Glengarry Child Care Society. All accidents and incidents that pertain to the child will be reported directly to the parent. Accident or incident reports shall be completed by attending staff and shall be signed by the parent at the end of the day

If a child shows any signs of illness, as outlined in the Health and Disease Policy, they will not be accepted into the program. The receiving Educator that notices any of these symptoms when a child arrives will ask that the child be taken home and to be seen by a Physician. A note from the Physician stating that the child’s condition is not contagious will be required. If a child displays any signs or symptoms of illness during the day, the child will be isolated and the parent or emergency contact will be called and asked to pick up the child.

Medication will only be administered with a signed Individual Medication Record. The medication must be prescribed by a physician, come in the original container with a prescription label indicating the child’s name, dosage and number of times per day that the medication should be administered. A medication form must be completed by the parent before the medication can be administered. Glengarry does not administer any homeopathic or herbal remedies to children.

All children are required to be properly dressed for the weather daily. All clothing is to be labelled with the child’s name. Two or three extra changes of clothes are to be kept at the centre in case of accidents.

Glengarry Child Care Society will take the children on outings and fieldtrips. The parent will sign the Field Trip Permission form at the time of registration which covers local field trips. Any field trips not covered by the Field Trip Permission form will require an additional consent form. The staff will complete the Field Trip Permission form and have the parents sign. Parents are invited and encouraged to volunteer for field trips

I understand that Glengarry Child Care Society reserves the right to terminate this agreement without notice, where in the judgment of the Society, this is justified by circumstances and in the best interest of the child/ren.

Please initial each permission consent below. I understand that I can decline my permission to any of the following.

I give permission for GCCS to post the following information regarding my child (first name, last name, birthday) within the centre. I understand that additional permission would be requested to post my child’s information outside of the centre (initial)

I give permission to the staff of Glengarry Child Care Society, to take my child on walks around the immediate neighborhood, within a 5 km radius from the Centre. I understand that Educators will take a list of all children, emergency contact information, first aid kit and a cell phone with them on all outings I understand that any outings not included in this agreement require a separate field trip permission form, which I will be required to sign (initial)

I give my permission to have photo’s taken of my child/ren to be posted within the centre. I understand that any external use of my child’s photo would require additional permission (initial)

I understand that the centre has a variety of pets and that my child may have access to them.

I understand the following;

- As with all pets, there is the possibility that my child may be bitten or scratched

- Pets will be permitted “out of cage” time while my child is in care

- My child may be involved in the care, feeding and cleaning of the pets and their living environments

Glengarry Child Care Society agrees to the following:

- To ensure that all pets are veterinary inspected prior to being brought into the program

- To access medical attention when necessary to ensure that all pets remain healthy

- To assist the children in caring for and interacting with all pets in a safe and appropriate manner

(initial)

I give permission for employees of Glengarry Child Care Society to apply sunscreen and bug spray to my child/ren according to the guidelines within the Parent Policy Manual. I understand that I must provide both sunscreen and bug spray that follows the guidelines outlined in the Parent Policy Manual.

(initial)

Glengarry Child Care Society has the right to terminate this agreement.

Parent Signature

Dated

Glengarry Child Care Society

Dated

A colourful automobile board game
A picture of four puppets on a table

HOURS

Monday - Friday
06:30 AM - 06:00 PM
Saturday - Sunday
Closed

CONTACT US

Glengarry Child Care Society

 

13315 89 St NW,

Edmonton, AB T5E 3K3

Phone

780-478-4691

 

Email

inquiries@glengarrychildcare.com

SOCIAL MEDIA

METHODS OF PAYMENT

Automatic debit

SERVICE AREA

Northern Edmonton and surrounding communities

“Glengarry Child Care Society acknowledges that we are on Treaty 6 territory, a traditional meeting grounds, gathering place, and travelling route to the Cree, Saulteaux (So-toe), Blackfoot, Métis, Dene (De-nay) and Nakota Sioux (Sue). We acknowledge the beliefs and traditions of many First Nations, Métis, and Inuit who have helped to shape this land.”

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