Home School Cooking Club

Home School Application

Please complete the form below to secure a place with us .
Which Culinary Class
Parent/Legal Guardian name*
Contact Email
Phone Number*

Area CodePhone Number
Parent/Legal Guardian name
Contact Email
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What we need to know about your child

To help make their time special
First Child's name*
First Child's DOB*
Any allergies or intolerance's. Please include any other information you feel we will need.*
Second Child's name
Second Child's DOB
Any allergies or intolerance's. Please include any other information you feel we will need.
Third Child's name
Third Child's DOB
Any allergies or intolerance's. Please include any other information you feel we will need.
Emergency Contact Details

We will always try to reach parents/care-givers first.
Emergency Contact
Phone Number

Area CodePhone Number
Relationship
Emergency Contact
Phone Number

Area CodePhone Number
Relationship
Please list everyone, including parents/care-givers, who may pick your child up.

Rows	Name	Relationship	Driving license number	Phone number
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2
3
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Medical Information

We hope to never need it, but we are erring on the side of caution
Doctor's name
Doctor's practice
Doctor's Phone Number

Area CodePhone Number
Doctors Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any medicine the child is currently taking
I authorize Cool Kids Create Club to use my child's first name along with pictures on their social media posts and newslettersI authorize Cool Kids Create Club to use my child's image, but no name, in their social media and newslettersI do not authorize Cool Kids Create Club to use my child's image
Cool Kids Create Club Rules and Reminders

Behaviour

Our goal is to establish and maintain a behaviour management system which will reinforce the following positive behaviours:

Respect Others in the club, adults and children
Respect Property of the club and school

If my child’s behaviour seriously violates the safety of any child or staff, I understand that he/she may be temporarily excluded from the program using 'time in' with a staff member and then rejoin the activities. In these circumstances, CCKC will inform me when I collect my child.

Illness
It is in the best interest of your child and the other children if you keep your child at home when he or she is ill. Children with fever, diarrhoea, or vomiting will not be admitted to the program. If a child becomes ill while at the program, the caregivers will be called immediately to pick up the child. Caregivers will be notified regarding contagious illnesses. Children will be readmitted when they are no longer contagious.

Medication
In accordance with state law, we will not dispense any medication to any child without advance written consent from the parent or guardian. Prescription medication may be given only to the child for whom it is prescribed. Over the counter medication must have the child’s name clearly printed on the container. The caregivers must complete a “Caregivers Permission to Administer Medication” form and give the form and the medication directly to the director in charge. All medication must be in its original container. If these steps are not completed, medication will not be administered. All medication must be in its original container with an accurate pharmacy label intact.

Attendance and Late Pick-Up

Parents/Guardians must notify staff if their child will be late or absent. This is for the safety of the child. If the child is registered to come and does not appear, we will check first with the school to see if the child was absent, and then we will call the parent and emergency contact numbers to locate the child. If your child is late being picked up, the extra charge will be $10 for the first 15 minutes then $5 for every 5 minutes thereafter.

Child Pick-Up and Drop-Off

Children will be signed in upon arrival at the program and caregivers must sign the child out and notify a staff member when a child is leaving early. At the end of the club parents/guardians are required to come in and pick-up their child and sign the child out. Caregivers will give the program the names of all persons authorized to pick up their children. Staff will ask for picture ID of anyone they do not know. Persons not listed as authorized to pick up will not be allowed to check out a child.
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Home School Application

What we need to know about your child

Emergency Contact Details

Medical Information