2020/2021 Enrolment Form for Salt Spring Co-op Preschool Society

2020/2021 Enrolment Form for Salt Spring Co-op Preschool Society
New Registrant Deadline: June 31
Child's Full Legal Name:*
Given Name to be Used in Preschool:*
Child's Birthdate *

DayMonthYear
Date
Gender*
Full Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Class Confirmed by ECE to be enrolled in:*

Monday/Wednesday class (mostly three yr olds)Tuesday/Thursday class (mostly four yr olds)Three days a weekAll four days a week
Confirmed Participation Level:*

Classroom FamilyNon-Classroom FamilyA combination of the two (only if more than one child/spot)
How did you hear about us?
Family Information
Parent / Guardian 1 *

Given NameSurname
Country of Birth:
Occupation:
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Cell Number

Area CodePhone Number
Parent / Guardian 2 *

Given NameSurname
Country of Birth:
Occupation:
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Cell Number

Area CodePhone Number
Child's Health
Names and ages of siblings at home: (Optional)
Languages Spoken at home:
Child's favorite activities and previous group experiences:
Please identify any areas of concern we may need to be aware about:
Please explain the kind of guidance and control methods that your child responds to:
Have you been a member of a VIPCA or another Coop preschool? If so, where and when? Has your family been involved in other group activities? E.g. Parent/Tot Groups, LaLeche League, Church, etc
Medical Insurance Plan Number:*
Effective Date:*

MonthDayYear
Date
Family Physician Name:*
Family Physician Phone Number*

Area CodePhone Number
Child’s Dentists Name:
Child’s Dentists Phone Number

Area CodePhone Number
General Health (check one):

GoodFairPoor
Medications Taken Regularly:
Allergies:
Special Diets:
Please include any dietary preferences (not allergies) here.
Disabilities vision, hearing, etc:
Serious Illness (past and current):
Other Concerns:
Child Immunization Record
My child has received immunizations.I choose not to have my child participate in the province’s immunization program.
Signature of Parent*

Clear

If your child has received immunizations, please indicate the DATES of immunizations on the chart below. Please format dates as: DD Month YR eg; 02 Feb 17*

	1st Visit @ 2mo.	2nd Visit 2mo after 1st	3rd Visit 2mo after 2nd	4th Visit 12mo old
DTaP-HB-IPV-Hib (Diphtheria, Tetnus, Pertussis, Hepatitis B, Polio, Haemophilus Type b)
DTaP-IPV-Hib (Diphtheria, Tetnus, Pertussis, Polio, Haemophilus Type b)
Rotavirus
Pneumococcal Conjugate
Meningococcal C Conjugate
MMR (Measles, Mumps, Rubella)
Varicella (Chickenpox)

Helper Parent Immunization Record
To the best of my knowledge my (parent) immunization status is:*

Complete and up to date.Some immunization but unsure of dates/completion.Not immunized.
Signature*

Clear
Today's Date*

MonthDayYear
Date
Is there a written agreement or order with respect to custody of your child? Yes

** If yes copy needs to be attached **

Under no circumstances is my child to be released to the following person(s):
Custody of Child
Is there a written agreement or order with respect to custody of your child?*

YesNo
** If yes, a copy needs to be attached **

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Under no circumstances is my child to be released to the following person(s):
Release of Children
Some parents may require other individuals to pick up their children from preschool during the year (e.g. nanny or grandparent).

I hereby authorize the Preschool (Early Childhood Educator or ECE substitute responsible in the school) to release my child to the following adults:

	Name	Address	Phone Number
Person 1
Person 2
Person 3
Person 4

Signature

Clear
Date

MonthDayYear
Date
Emergency Release

(1 or more contacts)

In the event of an emergency or other major disaster, I hereby authorize Salt Spring Cooperative Pre-school, Early Childhood Educator or ECE substitute responsible in the school, to release my child to the following adults. I understand that every effort will be made to contact me first.*

	Name	Address	Phone

Signature*

Clear
Date:*

MonthDayYear
Date
Designated Helper Parent Information and Records
Record of work history or experience with children if relevant - this experience can be volunteer or paid.
Workplace/Organization/Volunteer Work
Relevant Skills/Experience
* Please note: This training must be in the subject area of child development, guidance, health and safety or nutrition.
Parent Jobs

Our Co-op Preschool is run entirely by our valued parents. If you are interested in joinging our Executive Board please indicate your areas of interest below and we will evaluate incoming members based on interest/skill level as indicated & assign you a position that will best suit the needs of the preschool & your family. Please indicate your top 3 choices. *Please find detailed job descriptions in the ‘Parent Handbook’ on page 13.

Executive Positions: Please indicate your top 3 choices in order of preference with “1” being your most favored choice.

	Interested (pick 3)	1-3 order of favourites
President
Vice President
Treasurer
Enrolment
Marketing Chair
Secretary

Parent Areas of Interest: This information is collected to inform us of your areas of interest in the case that we are looking for extra volunteer help throughout the year. Please check any that apply.

Birthday Party HostFundraising Organizing / HelpingGardeningLibrary OrganizerArt / Craft HelperMaintenanceGrant WriterComposting/Recycling
Character References

References may be from a friend, co-worker or (one) family member who can support that the designated parent is of good character and has the personality, ability and temperament to work with children.) Please download the Character Reference PDF from our website's Parent Page, print and have it signed, then scan and upload as a PDF using the below uploader.
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Field Trips
During our preschool year, we generally have 3 - 5 field trips where families are required to drive children to the field trip location. Places we may visit include the fire hall, an island farm, beaches and an off-island skating trip. Families will be notified well in advance of upcoming field trips through the newsletter, general meetings, and field trip information forms - given out by the ECE and written on our outdoor school room’s chalk board. The preschool session will then take place at the sight of the field trip. It is the responsibility of your family to make arrangements for your child to get safely to and from the selected field trip.

1) The Preschool Requires one parent/caregiver to attend with their preschool child on these special outings. Field trips provide a wonderful opportunity for parents to connect with their child and participate together.

Our Ratio of 1 adult to 2 children applies for families that are looking for another caregiver to attend with

their child. Siblings are welcome to attend MOST field trips at the discretion of the parent.

2) Some Field trips may be slightly shorter or longer than a usual pre-school session, depending on weather, distance, and the general nature of the field trip. Outings will be arranged for each class individually and take place n the same week, with the exception of the off-island trip in which both classes will attend together.

3) By signing this field trip permission form field below, I understand the preschool participation requirements for my child and that alternative arrangments may be necessary on field trip days.
Walking Field Trips: During the year, we may want to take walking field trips in the area around the school. This may include walks in the neighborhood, or to the school fields or playgrounds. Some hazards may include falls, and crossing roads. This form will serve as a permission form for both types of field trip for the entire school year.
Parent Name:*
Parent Signature*

Clear
Date:*

MonthDayYear
Date
Photo/Media Release Consent Form
I hereby agree and give my permission for the Salt Spring Cooperative Preschool (school) and/or its partners to record, film, photograph, audiotape or videotape my/my child’s name, image, student work, and performance (hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the school website, posting in the school, posting on social media sites, other media print and online websites and/or for broadcasting on television or radio as determined by the school for marketing, fundraising, communication and general community awareness

I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works.

I understand that the Works may appear in electronic form on the Internet or in other publications outside of the school’s control. I agree that I will not hold the school responsible for any harm that may arise from such unauthorized reproduction.

I have read this Student Media Release Consent Form and I fully understand the contents and meaning of this release.
Please mark the relevant boxes:*

I AGREE that my child may participate in being recorded.I wish that my child participates in ONLINE media outlets ONLY.I DO NOT WISH my child to participate in being recorded in ANY multimedia form.
Students Name:*
Parent Signature*

Clear
Date:*

MonthDayYear
Date
PARENT AGREEMENT CONTRACT
Vancouver Island Cooperative Preschool Association – VICPA Salt Spring Cooperative Preschool Society is a member school of the V.I.C.P.A. for the school year 2020/2021.

We, the undersigned have read carefully the policies & procedures (found in the Parent Handbook) of Salt Spring Cooperative Preschool Society and agree to abide by them. We will also read the Early Childhood Educator's (ECE) Contract when available.
1. When acting as a Helping Parent*, I agree to arrange to arrive 15 minutes before preschool opening and to stay approx 30 minutes after preschool closing. So that both my child and I may get the most out of this special day, I will not bring any other children to the preschool. If I cannot be present, it will be my responsibility to trade Helping Parent days with another qualified Helping Parent and notify the Helping Parent Day Scheduler.
2. We will make every effort to be prompt in bringing, and picking up our child for preschool.
3. We will not send our child to school if the child is ill, nor will we come as the Helping Parent when we are ill. If my child contracts a communicable disease or condition (i.e., chicken pox, head lice, pink eye, etcwe will notify the ECE immediately.
4. We understand that, in the school room and on the playground, the ECE has overall responsibility, for the program, teaching methods, discipline and health and safety measures; on a Helping Parent day, the parent/caregiver is there as the ECE & ECE assistants helper.
5. We hereby authorize the ECE to:
  a) Arrange for periodic examinations by public health personnel;
  
  b) Send our child home, if we are unable to pick him/her up, accompanied by an adult approved by us, if he/she appears ill, when it has been ascertained there is someone there to receive him/her;
  
  c) In case of serious injury or other medical emergency, to obtain professional help (family doctor and/or ambulance) and notify the parents/caregivers immediately. We agree that any cost incurred for such services shall be the sole responsibility of ourselves. If parents/caregivers cannot be reached contact is then made with the person whose name appears as an alternate on the enrolment form, and emergency form;
  
  d) To exercise ensure the safety and well-being of our child.
6. We will keep the ECE informed of any event or change of routine at home that may affect our child's behavior.
7. If we have questions about our child's progress or the program of the preschool, we will direct them to the ECE; we will direct queries or suggestions about the administration of the preschool to the executive through the President or Personnel Committee.
8. We will pay our child's tuition fees according to the policies & procedures laid out by the preschool, found in the Salt Spring Cooperative Preschool Society’s Parent Handbook.
9. If it becomes necessary to withdraw our child from the preschool, we will give one month notice in writing to the Enrolment Chair,
  and/or pay one month's tuition in lieu of notice. We understand that in some circumstances (and after March 1st), tuition is non-refundable as outlined in the Salt Spring CooperativePreschoolSociety’sPoliciesandProceduresfoundintheParentHandbook.
10. TO BE A FULLY COOPERATIVE MEMBER OF THE PRESCHOOL, WE WILL SERVE ON THE EXECUTIVE, ON A COMMITTEE, OR TAKE ON A JOB(S), AND TO ASSIST IN GENERAL UPKEEP AND THE FUNDRAISING FOR THE PRESCHOOL.
11. EDUCATION PROGRAM (10 hours required). Participation in an ongoing Parent Education Program is a requirement to maintain compliance with Community Care Facility Act, Child Care Licensing Regulation. We understand that the presence of one helping parent/caregiver per family is required at every meeting, and that our family will be asked to withdraw from the preschool group if more than two general meetings are missed. We are aware that telephone contact with the secretary is necessary in the event of an unavoidable absence and that the posted minutes of the meeting must be read and signed and Parent Ed must be followed up as per VICP A Standards.
  
  We undertake to attend all MONTHLY MEETINGS, for the purpose of conducting society business and the PARENT
12. We will take an active interest in the Vancouver Island Cooperative Preschool Association (V.LC.P.A)
13. We understand that in accordance with the Child Care Licensing Regulations, it is compulsory for the helping parent/caregiver born or raised in countries where tuberculosis is endemic; to have a TB test that proves they do not have active tuberculosis. A copy of the results of this test must be presented to the Enrolment Chair and will be kept on file at the preschool. This process must be completed before the parent/caregiver begins their helping parent day.
14. We agree to make every effort to present the forms for items 13 and 14 at the time of registration and no later than 2 weeksafter our child has commenced preschool THESE FORMS ARE LICENSING REQUIRMENTS FOR THE LEGAL OPERATION OF OUR PRESCHOOL. Parent cannot assist as duty parent until above mentioned documents have been received by the Enrolment Chair. Children cannot attend the program fully until all their registration forms have been submitted.
15. We understand that according to government regulations, all helping parents are unable to do participation days in the classroomwithout a Criminal Record Check in accordance to the Criminal Record Review Agency (Schedule E).
16. For insurance purposes it is recommended that we ask the following question. Please circle one answer. To the best of your knowledge, have you ever been accused of an act of abuse or neglect against a child?*

YesNo
17. We understand that the use of the preschool facilities and the activities which our child or children undertake during program hours involves some risk of minor physical injury. We hereby release and discharge the V.I.C.P.A., the Salt Spring Cooperative Preschool Society and its employees and volunteers from any actions, causes of action or liability which we may have individually or have on behalf of our child or children in excess of the public liability insurance carried by V.I.C.P.A. and the society.

This Parents' Agreement form and in particular, the waiver-release clauses herein contained represent the entire agreement between the parties and the said terms are contractual in nature and not a mere recital.
We have read the Parents' Agreement form in its entirety and confirm that we know the contents of this agreement and that we sign the agreement voluntarily.
Parent Signature:*

Clear
Date:*

MonthDayYear
Date
Witness Signature:*

Clear
Date:*

MonthDayYear
Date
Witness Occupation:*
Witness Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This bottom portion is for families participating for a consecutive year. I/we have re-read this Parent Agreement Contract.
Caregiver 1 and Designated Parent Helper Name:
Signature

Clear
Date:

MonthDayYear
Date
Should be Empty:

2020/2021 Enrolment Form for Salt Spring Co-op Preschool Society

Family Information

Child's Health

Child Immunization Record

Helper Parent Immunization Record

Custody of Child

Release of Children

Emergency Release

Designated Helper Parent Information and Records

Parent Jobs

Character References

Field Trips

Photo/Media Release Consent Form

PARENT AGREEMENT CONTRACT

We have read the Parents' Agreement form in its entirety and confirm that we know the contents of this agreement and that we sign the agreement voluntarily.