Elora Co-op Pre-School Registration 2022-2023

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.

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

Postal
What % of the time is the child at this address *

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

Postal / Zip Code
What % time is the child at this address

Pick-up List

Information for those allowed to pickup from school, aside from care giver
Individual 1
Individual 2
Individual 3

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

Medical History
Doctors Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

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

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

Pre-School Advertising

How did you originally hear about the Elora Co-operative Preschool?
Online Search Signage Family/Friends Facebook Ad's

Consent Form
Child's name *

First Name Last Name
1. 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.
2. 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.
3. 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.
4. I agree to view the contents of the Handbook and Policy Manual online www.elorapreschool.ca and familiarize myself with the contents therein.
5. 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.
6. 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.
7. 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

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? *

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

CAD $40/ family ( 2 children $20 each ect.)

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: