Elora Co-op Pre-School 2022-2023
Students name
First Name
Last Name
Nickname (if applicable)
Gender
*
Male
Female
Date of Birth
*
How many months old is your child in September?
Child must be 18-30 months for Mondays Morning and 30+ months to register for Tuesday- Friday classes.
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Caregiver Information
Caregiver 1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship to Child
*
example: Mom
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Province
Postal
What % of the time is the child at this address
*
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Caregiver #2 Information
Caregiver 2
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Relationship to Child
Example: Mom
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What % time is the child at this address
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Pick-up List
Information for those allowed to pickup from school, aside from care giver
Individual 1
Individual 2
Individual 3
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Students Personal History
Child's Siblings (ex. Ian age 1)
Other Members of the Household (Ex. Audrey, Grandma)
Is there other information we should be aware of that may affect your child's behaviour?(ex.divorce, family illness)
Other languages spoken at home
ex. French
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Medical History
Doctors Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Health Card Number
(Optional)
Allergies
*
N/A if no known allergies
Special Needs
*
Medications, Therapies ect. or N/A if not applicable
Has your Child had any of the following tests?
Yes
No
Eye Test
Hearing Test
Hospital Stay
Communicable Diseases
Language Assessment
If yes, please explain
Was your child full term?
Yes
Additional Comments/
Information which would be helpful in the provision of care
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Emergency Contacts
Emergency Contacts should be someone other than a caregiver. A contact that is local is preferred, however if there is no one local, it is still important to include a contact for situations when caregivers are unreachable. We will always contact the caregivers first.
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Permission Slip
Sunscreen/Hand Sanitizer/Diaper Cream
I give the Elora Coopeative Preschool permission to apply hand sanitizer, diaper cream and sunscreen I have provided with, labelled with my child's name.
Yes
No
Consent to Emergency Medical Treatment
I/We hereby give permission for the child in my/our care to receive emergency medical treatment in the even that I/we cannot be contacted
Consent to Emergency Medical Treatment Caregiver 1
*
Consent to Emergency Medical Treatment Caregiver 2
Today's Date
*
-
Month
-
Day
Year
Date
Immunization Record
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Pre-School Advertising
How did you originally hear about the Elora Co-operative Preschool?
Online Search
Signage
Family/Friends
Facebook
Ad's
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Consent Form
Child's name
*
First Name
Last Name
I hereby grant permission for my child to use all the play equipment and to participate in activities provided by Elora Co‐operative Pre‐School Inc.
I hereby grant permission for my child to participate in excursions while at Elora Co‐operative Pre‐ School Inc. Parents will be notified one week in advance of any anticipated excursions.
I hereby grant permission to Elora Co‐operative Pre‐School Inc. to reprint photographs of my child participating in school activities on promotional materials, informational brochures or the school’s website. I understand that these photos will not be used for or sold for profit‐making or commercial purposes.
I agree to view the contents of the Handbook and Policy Manual online www.elorapreschool.ca and familiarize myself with the contents therein.
I understand the applicable fees, fines and monthly payout options. By not selecting any of the payout options, I agree to fulfill all of my co‐operative duties. These include classroom helper days (if selected) and committee/fundraising responsibilities to make the preschool a better place for the child in my care to attend.
I understand that I am required to attend both of the mandatory semi‐annual general meetings in September and in May, participate in my assigned committee and participate in the spaghetti supper fundraiser. This is to ensure that the preschool maintains our high standards as a co‐operative and to assist in decision‐making and future planning.
I give consent for the preschool to share my name, phone number and email address for the purposes of communicating school business between parents, board members and teachers.
Consent Form Signature
*
Date
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Co-Operative Duties
For 45 years the preschool has been founded on the dedicated volunteer hours from the parents of the preschool. These hours helped to keep the cost of maintaining the preschool low and connected families. For the upcoming school year preschool duties cannot operate as usual due to COVID. Volunteering jobs will be sent out as they become available for parents to complete.
Do you wish to opt-out of your preschool volunteer duties?
*
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Class Selection: Mondays Morning, children 18-30 months in September, Tuesday-Friday children must be 30 months in September. ( **Monday, Tuesday and Thursday afternoon classes may change subject to demand) Prices may also change based on the new government childcare program.
If your selection is not available please indicate which waitlist you would like to be placed on.
ex. Full day program
Family Registration fee
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( X )
CAD
$40/ family ( 2 children $20 each ect.)
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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