2026/2027 Enrolment Form for Salt Spring Co-op Preschool Society

2026/2027 Enrolment Form for Salt Spring Co-op Preschool Society
New Registrant Deadline: September 2 2026
Child's Full Legal Name:
Given Name to be Used in Preschool:
Child's Birthdate

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Gender
Full Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Class Confirmed by ECE to be enrolled in:
Confirmed Participation Level (there are only a couple of non-classroom spots available) :
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
2 digit month, 2 digit day, 4 digit yearDate
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):
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
Signature of Parent

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

Rows	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:
Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Custody of Child
Is there a written agreement or order with respect to custody of your child?
** 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:

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

Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.

Rows	Name	Address	Phone

Signature
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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 favoured choice. (* = indicates not full executive role. Discuss with President)

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

Parent Areas of Interest and/or Expertise: 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.

Other
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 2 - 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
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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:
Students Name:
Parent Signature
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PARENT AGREEMENT CONTRACT
During our preschool year, we generally have 2 - 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.
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?
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:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Witness Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

2026/2027 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.