Summer Camp/ Drop-in Parent Package

Summer Camp/ Drop-in Parent Package
Child Family Profile

The following questions are designed to assist Steps Academy members of staff with information about your child to provide the best, most appropriate care. This information is confidential and will not be shared. These questions are meant to initiate mutual trust and respect with families that will develop into a strong, cooperative partnership between parents and Steps Academy.
Child's Name*

First NameLast Name
Gender*

MaleFemaleX
Birth Date*

MonthDayYear
Health
Does your child have any allergies?*
What allergies does your child have?
How should we respond if they have a reaction?
Does your child have any pre-existing health conditions?*
Example: Heart Condition, Asthma
Please Describe
Has your child had any assessments or screenings for any disabilities or disorders?*
Does your child have any disabilities or disorders?*
Example: ADHD, Autism, Cerebral Palsy
Please Describe
Is your child currently taking any medication?*
Will the medication need to be administered while they are in our care?
Please list any side effects we should be alerted to
What medications are they taking? If your child is taking any prescription medication (even if not administered at the centre) it is important to document that here.
If anything changes while your child is registered with us, please update this information via email to registration@stepsacademy.ca
Parent Name*
Signature*

Clear

Behaviour
Is there anything that you wish to share with us about your child? This would be anything that you think is important for us to know in order to provide your child with the best care possible.*
Likes/Dislikes, fears, how we should respond to certain behaviours etc

Eating Preferences
Does your child have any food allergies or sensitivities?*
What are allergies or sensitivities to and what is their reaction?
Does your child have any dietary restrictions*
EX: No Beef, No Pork, Vegetarian etc
What are the dietary restrictions?

Guidelines for Behaviour Management
Appropriate behaviour is encouraged and praised. When undesirable behaviour occurs, positive guidance and redirection of a child's attention is generally sufficient action to end it.

In extreme situations, a child may be given reflection time to think about their actions in the classroom, or be removed from the classroom to give them a chance to think about and/or talk about their behaviour.

Physically aggressive behaviour, such as biting, kicking, hitting etc. cannot and will not be tolerated. To protect all of the children and encourage acceptable behaviour, instructors will intervene immediately if a child becomes physically aggressive.

Steps Academy staff will make every effort while children are in our care. However, parents/guardians must understand that consistently aggressive disruptive behaviour is unacceptable and may result in dismissal from the program.

With regard to behavioural management issues, Steps Academy ensures that child guidance methods utilized in the program are communicated to:
- Parents
- Staff
- Children, where developmentally appropriate, and any child guidance strategy taken is reasonable and appropriate in the circumstances.
With respect to a child in the program, Steps Academy will under no circumstances engage in the following:
- Inflict or cause to be inflicted any form of physical punishment, verbal or physical degradation or emotional deprivation
- Deny or threaten to deny any basic necessity
- Use or permit the use of any form of physical restraint, confinement or isolation
- Inappropriate Behaviours
Behaviours that persist over time which are disruptive will be documented by program staff. Program Supervisors will notify parents if behaviours are persistent and if all compassion-based strategies to modify behaviour to reflect positive habits are not effective. We are happy to work with parents by suggesting community resources if needed to help children modify inappropriate behaviours.

However, Steps Academy reserves the right to terminate care if after these efforts, it is determined that Steps Academy cannot meet the child's needs.
Parent/Guardian Name*
Signature*

Clear

Photo and Video Permission
Lillio

Lillio is a software program that allows us to share photos and videos of your child with you. Lillio is used daily for communicating updates and information about your child and the centre which will be sent directly to you using the email you provided us.

If you choose not to receive photos, you will still receive updates and information about your child and the program through Lillio. This is our prime method of communication, and it is your responsibility to make sure you are checking the app frequently to ensure you do not miss any important updates.

**Regardless of your choice, your child's photo may appear in our Centre Newsletters, as well as the TV or Smart Board in the front lobby.

Sometimes other children in the center may be featured in photos, videos or stories of your child. By giving your consent, you agree not to share photos or video of any child, other than your own, outside the program without permission.
I give consent for my child to have their photos shared through Lillio *
1. Parent/Guardian Name*
Email*
example@example.com
2. Parent/Guardian Name
Email
example@example.com
I give permission for my child, to be photographed/appear in video, while attending Steps Academy for:
Steps Academy Website*
Social Media - Facebook, Instagram etc.*
Marketing Materials (Posters, Flyers, Brochures etc.)*
I understand that it is my responsibility to update this form if I no longer wish to authorize one or more of the above uses. If you grant permission for use of photos and if at any time, there is a photo that you wish to have removed please contact the office and we will edit or remove the photo.

**No child names will be displayed by Steps Academy**
Parent/Guardian Name*
Signature*

Clear

Illness Policy
Please note, for the health and security of all families we reserve the right to make assessments regarding children's health. As a preventative measure we may err on the side of caution within our assessment to avoid the spread of illness/disease.
- Pain - any complaints of unexplained or undiagnosed pain or discomfort
- Fever (100°F/37.5°C or higher) Sore throat or trouble swallowing
- Unexplained diarrhea or loose stool combined with nausea, vomiting or abdominal cramps.
- Nausea or vomiting
- Severe itching of body and scalp
- Known or suspected communicable diseases
Children can return following a 24 hour symptom-free period

You are required to keep (or take) your child home when your child:
1. Is suffering from one or more of the above symptoms
2. Is not well enough to participate in the activities at Steps Academy including outdoor time
Upon pickup parents may be asked to sign the illness form acknowledging that their child will be symptom free, without the aid of symptom reducing medications such as Tylenol, etc., for a full 24 hours prior to returning to Steps Academy. We reserve the right to send any child who is exhibiting these symptoms home.

If you wish for your child to return to the program prior to the 24 hours, they will need to receive a doctor's note that says the child is healthy enough to return to our centre and is able to participate in all aspects of our daily programming.

Parents will inform Steps Academy within 24 hours of a diagnosis of a serious illness or contagious disease of a communicable nature in the family. This is to protect all families who attend Steps Academy. Failure to do so is grounds for immediate termination of care.
Parent/Guardian Name*
Signature*

Clear

Medications
Prescription medications will only be given to a child in care with the following conditions:
- Parent provides written permission to Steps Academy complete with full instructions regarding dosage and times of day to administer prescription medication. (Forms are available for this purpose for parent(s) to complete.)
- All prescribed medications must have the child's name clearly indicated on the prescription bottle.
CARE OF A SICK CHILD AND NOTIFICATION OF PARENTS

When a child becomes ill, they will be able to rest in a designated quiet and comfortable area and will be closely supervised until the parent/guardian arrives. Once the parent/guardian arrives they may be asked to sign the Child Illness Record for your child’s file.

Parents will be notified immediately and agree to begin making alternate work arrangements or arrangements for alternate care. If your child is seriously ill, you or an alternate must come for the child IMMEDIATELY. If parents cannot be reached, the emergency contact list will be consulted or the child's doctor may be contacted depending on the seriousness of the illness.
Parent/Guardian Name*
Signature*

Clear

Non-Emergency Health Consent

Sunscreen, Lip Balm and Lotion
I give permission for the staff at Steps Academy to apply a sunscreen product, which I have provided, when my child will be playing outside during the months of June to September. I understand sunscreen may be applied to exposed skin, including but not limited to the face, tops of ears, bare shoulders, arms and legs. I will apply sunscreen before my child arrives to Steps Academy in the morning.
Please choose from the following*

I do not know of any allergies my child may have to sunscreen.My child is allergic to some sunscreens. Please only use the brand of sunscreen I have provided from homeI do not want my child to wear any sunscreen
Parent/Guardian Name*
Signature*

Clear

Child Drop-Off and Pick-Up Policy
A parent or guardian must authorize up to 3 individuals to pick up their child from child care Authorized individuals will be required to present valid identification and provide the “ safe word” to pick up any child from our care. This is in addition to the parent/guardian.

I authorize the following individuals to pick up my child from the child care:*

	Name	Phone Number	Phone Number
Person 1
Person 2
Person 3

If an authorized individual without valid identification or an unauthorized individual comes to pick up my child from child care, I can be contacted at this number:*
Please choose a safe word / code word *
This code should be 5 to 14 characters long and one you can remember but not easily guessed.
All alternates without a code word or ID must report to the office at pick up. To avoid any unnecessary delays or confusion, please ensure you have relayed the safe/code word and reminded your alternate to bring ID when picking up.
Release of a Child

Parents are required to indicate the name and phone number of all authorized individuals who are clear to pick up the child.

Unauthorized Pick Up

The parent/guardian is required to notify Steps Academy in writing (personal email) if someone else, other than the authorized persons, will pick up their child. Please provide name, phone number, and description of the person. The person will be asked to show photo identification and will need to have been provided the “safe word.”

Custody and Related Court Orders

Steps Academy staff cannot become involved in the marital or custody issues of enrolled families. If a custody or court order exists, a copy of the order needs to be placed in the child's file. The guardian is responsible for providing up-to-date and accurate information concerning the legal guardianship of the child. Without a custody or court order on file, Steps Academy staff cannot deny access to the non-enrolling parent. If the non-enrolling parent is not listed on the pick up list, the policy on “Unauthorized Pick Up” will be implemented (see above).

Emergency Contact List
Please provide the names and phone numbers of 3 additional persons to contact in case you cannot be reached:

*Please note these contact individuals should have knowledge of the code word you have listed below*

Alternate Emergency Contact Information*

	Name	Relationship	Cell Phone	Home Phone
Name 1
Name 2
Name 3

I agree that all the above-mentioned persons have provided their consent to be named on my Emergency Contact List at Steps Academy.
Parent/Guardian Name*
Signature*

Clear

Community Walk Form
I give permission for my child to participate in Community Walks. Information about these walks will be posted on the classroom door. This information will include a map of the route taken, the number of children and staff on the walk as well as the departure and return time.

Safety Measures taken by Steps Academy Staff during this trip:
- First Aid Kit in Transport bag
- Portable records of all children
- Office informed of location, time, route walked and number of children
- Any medication and forms that may be required to be administered during the child’s time with us
- Frequent head counts
- Ratio always maintained
- Rules discussed prior to each trip
- Inform the office of the walking route and location
- Posted walking route and location on classroom door
- Cell Phones for any necessary communication and photos
Parent / Guardian Name*
Signature*

Clear

Consent for First Aid / Ambulance / Medical Care / Treatment
I give permission that my child may be given emergency First Aid treatment by a staff member of Steps Academy.
Initial* I give permission for my child to be transported by ambulance or other means available at the time to an emergency centre. I understand that any and all costs incurred due to emergency ambulance transport are solely my/our responsibility.

Initial * In the event that I cannot be contacted immediately, medical care and treatment can be administered to my child by a physician in the case of an accident or emergency.
Parent/Guardian Name*
Signature*

Clear

Liability Release Form
In consideration of allowing the previously declared participant(s) to begin participation in Steps Academy activities, while on the premises and property of said centres, the undersigned, for themselves, and/or being the legal and acting guardian of participant(s), acting for themselves and on behalf of the participant(s), release and hold harmless Steps Academy, its owners, employees, and agents of and from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned while in or upon the premises upon which Steps Academy is conducted, or any premises under the control and/or supervision of Steps Academy, its owners, officers, employees, or agents or in route to or from and of the said premises, or while at any premises or place when activities sponsored by or participated in by Steps Academy, its owners, officers, agents or employees.
Parent/Guardian*
Signature*

Clear

Transportation Waiver
I give permission for my child First Name* Last Name* , to be transported by steps academy on field trip days.
✓ I understand that Steps Academy will take all reasonable precautions to provide care and safety.

✓ I acknowledge the potential of unknown risks and I voluntarily assume the risks inherent in the transportation outlined.

✓ I release Steps Academy from and agree not to sue for any claims I or my child may have arising from, or in connection with, any bodily injury, property damage, or loss, which my child may suffer from any cause whatsoever.

✓ I release Steps Academy from, and agree not to sue, for any bodily injury, property damage, or loss, which my child may suffer resulting from Acts of God, or the activities or the acts or omissions of any other organization or individual over whom Steps Academy has no direct control.

The responsibilities of the parent/guardian are as follows:

✓ This form is required to be completed in order to authorize that Centre personnel can transfer children on the bus.

✓ At home, discussions with your child regarding bus safety rules.

✓ Ensure your child is wearing their camp shirt on field trip days.

The responsibilities of the child care centre are as follows:

✓ All staff will follow centre policies and procedures as well as the Alberta Child Care Regulations for ratios, supervision and transportation.

✓ Staff will have a cell phone to reach parents or the centre director if required.

✓ Staff are trained in First Aid and will have a first aid kit on the bus as well as in the evacuation bag, along with emergency contact numbers and the portable records of the children.

✓ Staff will do frequent head counts and confirm the attendance of children.

✓ Signage indicating field trip location, time leaving and returning will be posted and shared via Lillio with families.
Parent/Guardian*
Signature*

Clear

Portable Record Information
Child's Name*

First NameLast Name
Child's Birthdate*

MonthDayYear
Date
Effective Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian 1 Information
1. Name*

First NameLast Name
1. Cell Phone Number*
Please enter a valid phone number.
1. Work Phone Number*
Please enter a valid phone number.
Is your address same as above?*
1. Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian 2 Information
2. Name

First NameLast Name
2. Phone Number
Please enter a valid phone number.
2. Work Phone Number
Please enter a valid phone number.
Is your address the same as above?
2. Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Emergency Contact Information

This cannot be a parent's information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Is your child familiar with this person?*
Address*

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code
Medical, Allergies, Sensitivities or Dietary Restrictions
If your child has any allergies, sensitivities or dietary restrictions please let us know below:*
Dairy allergy, Epi-Pen Peanut allergy, Vegetarian, No Pork
Does your child have an Epi-Pen *
Does your child have an Inhaler that may be required while in our care? *
Is your child currently up-to-date with their vaccinations?*
Parent/Guardian Name*
Signature*

Clear

Epi-Pen Administration Form
Name*

First NameLast Name
This child has allergies to the following:*
Name of Medication*
Dosage Amount*
Description of reaction to this allergy*
Please upload a recent headshot of your child*

Cancelof
Emergency Measures
- Get EpiPen (epinephrine) or other medication and administer immediately.
- HAVE SOMEONE CALL AN AMBULANCE and advise of need for an EpiPen.
- Unless student is resisting, lay student down, tilt head back and elevate legs.
- Cover and reassure student.
- Record the time at which the EpiPen was administered.
- Have someone call a parent.
- If the ambulance has not arrived in 10 – 15 minutes, and breathing difficulties are present, administer a second EpiPen.
- Even if symptoms subside, students require medical attention because there may be a delayed reaction. Take the student to the hospital immediately in the ambulance.
- If possible, have the parent or a school staff member accompany the student to the hospital.
- Provide ambulance and / or hospital personnel with a copy of the Severe Allergy Alert Form for the student, and the time at which the EpiPen or Medication was administered.
I understand I have been asked to disclose the above student’s identifying information and I am aware of the risks or benefits of consenting or refusing to consent to the disclosure. I voluntarily give the school consent to place a copy of this form in the student’s cumulative student record, to post this form including the student’s picture in appropriate locations within the school, to take the Emergency Measures, and to share this information as necessary with the staff of the school and health providers.
Parent/Guardian Name*
Signature*

Clear
Today's Date

MonthDayYear
Date

Medication Authorization Form
Child's Name

First NameLast Name
Medication Name*
Dosage Amount*
Medication Start Date*

MonthDayYear
Medication End Date*

MonthDayYear
If for an Epi-Pen please enter Expiration Date
Symptoms to watch for prior to administration*
Symptoms following administration of medication*
Has your child received this medication before (Epi-Pen Excluded)*
Parent/Guardian Name*
Parent/Guardian Signature*

Clear
Should be Empty:

Summer Camp/ Drop-in Parent Package

Health

Behaviour

Eating Preferences

Guidelines for Behaviour Management

Photo and Video Permission

Illness Policy

Medications

Non-Emergency Health Consent

Child Drop-Off and Pick-Up Policy

Emergency Contact List

Community Walk Form

Consent for First Aid / Ambulance / Medical Care / Treatment

Liability Release Form

Transportation Waiver

Portable Record Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact Information

Medical, Allergies, Sensitivities or Dietary Restrictions

Epi-Pen Administration Form

Medication Authorization Form