Before & After School Care Information
2022-23
Please fill out for all children attending Autism REC before and after care.
1st Child's Name:
*
First Name
Last Name
Gender:
*
Male
Female
Type a question
*
Before School Care
After School Care
Before & After School Care
Child Care - ages 2-3 years old (All day care)
Child Care - ages 4-5 years old (All day care)
Transportation
Subsidized Program
Date of Birth:
*
-
Month
-
Day
Year
Date
2nd Child's Name:
Gender:
Male
Female
Date of Birth:
-
Month
-
Day
Year
Date
Type a question
*
Before School Care
After School Care
Before & After School Care
Child Care - ages 2-3 years old (All day care)
Child Care - ages 4-5 years old (All day care)
Transportation
Subsidized Program
Name and address of child(ren) school:
Please add addition children here:
Parent/Guardian Contact Information:
Mother's Name:
Mother's Email:
Mother's Cell Phone:
-
Area Code
Phone Number
Mother's Home Phone:
-
Area Code
Phone Number
Mother's Work Phone:
-
Area Code
Phone Number
Father's Name:
Father's Email:
Father's Cell Phone:
Father's Home Phone:
Father's Business Phone:
Child's primary Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First Language spoken at home:
Second Language spoken at home:
Do your children have health issues? If so please describe:
Do your children have allergies? If so list here.
Do your children have any physical, social, or emotional challenges we should be aware of? If so describe here:
Two other people to contact in case of emergency if parents cannot be contacted:
First Emergency Contact's Name
*
First Name
Last Name
Release for Pick ups
*
Yes this person can pick up
No this person cannot pick up
Relationship to Child:
*
Cell Phone:
*
-
Area Code
Phone Number
Home Phone:
-
Area Code
Phone Number
Second Emergency Contact's Name
*
First Name
Last Name
Release for Pick ups
*
Yes this person can pick up
No this person cannot pick up
Relationship to Child:
*
Cell Phone:
*
-
Area Code
Phone Number
Home Phone:
-
Area Code
Phone Number
Release for Pick ups
I give permission to the following individuals to act as parent designates to pick up my child(ren) from Explorers.
Please list the names of the people into whose custody we may dismiss your child(ren). Your children will not be allowed to leave the school with anyone not listed below. You can add people to this list at any time.
Name
First Name
Last Name
Relationship to Child:
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relationship to Child:
Phone Number
-
Area Code
Phone Number
Please list others that can pick up here:
Please provide any further information relating to your child that would be helpful in understanding and caring for your child:
Payments are DUE Sept 5th, 2020Payment options will be outline in the Explorer confirmation Email once all school year is decided. Cheque payments are made out to ExplorersFees are pre-paid monthly with 10 postdated cheques for the 1st or 15th of every of every month or one for prepaid casual care. or 10 etransfers set up monthly.For the first and second child of the same family the above rates apply, for third/fourth child the rate is 25% disscount.
AGREEMENT: One month written notice to withdraw or change your registration status of your child is required. Notice must be given on the first of the month. I understand that a full social resume must be completed before my enrolment is complete. I hereby acknowledge that I am aware of the conditions stated in this agreement and agree to abide by these requirements.
COVID-19 Warning & Disclaimer : COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe llness, personal injury, permanent disability, and death. Participating in programs or accessing Explorers facilities could increase the risk of contracting COVID-19. Explorers in no way warrants that COVID-19 infection will not occur through participation in our programs
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