After School Care Registration Form

25/26 After School Club Registration Application

Rutland Parent Participation Preschool Society
Information of Child
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

FemaleMale
What grade is your child enrolled in for September 2025:*

KindergartenGrade 1Grade 2Grade 3-5
What school is your child enrolled in:*

Quigley ElementaryOther
I understand that pick up is only available on site at Quigley. If your child is coming from another school, they must be dropped of at Classroom 18 - 705 Kitch rd at/after 2:30pm.*

Yes
Days of the week desired:*

MondayTuesdayWednesdayThursdayFridayAll days offeredMy care needs will vary through the yearOther
Rates Reminder:

Our Parent Portion of rates are $15 for after school care, and $30 for days where care is extended beyond 4 hours (typically school early dismissal dates). We are currently enrolled in the ChildCare Fee Reduction Initiative which subsidizes a portion of the prices at RPPP. The prices here reflect the price after that discount.We recommend all families apply from subsidy through the Affordable ChildCare Benefit as that can further reduce your out-of-pocket portion.
Information of Parent/Guardian 1
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Information of Parent/Guardian 2
Parent Guardian 2:*

Lives with Parent/Guardian 1Lives Elsewhere (Please complete address and contact info below)Not Applicable
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address - If applicable

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload any relevant custody orders that are currently in place.

This is compulsory and is for your child's protection and well-being.
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Emergency Contact 1
In the event of an emergency, please contact:
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address
example@example.com
Emergency Contact 2
In the event of an emergency, please contact:
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address
example@example.com
Other people authorized to pick up child from school
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Relationship
Phone Number
Please enter a valid phone number.
Medical Information
Doctor's Name*

First NameLast Name
Doctor's Phone Number*
Please enter a valid phone number.
Please list any of the following: Current medications, known/suspected allergies, special diet (for any reason - ie: kosher, vegan, halal, dairy free), medical diagnosis or concerns you wish to disclose:*
Does your child require any extra support to integrate or participate safely?*
Child's Care-Card Number:*
Please do NOT leave blank
Please upload a photo of your child's Birth Certificate here*

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Please upload any immunization/vaccination records for your child here

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Please upload a photo of your child's face for our emergency files. *

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Below is a PDF of our Parent Handbook. Please ensure you have read and downloaded this Handbook. Paper copies can be requested as well in class.
I understand that this application is not a guarantee of acceptance. Once my application is confirmed, I will be notified. If there is space for my child, I agree to pay a non-refundable fee of $100. This can be done *AFTER CONFIRMATION* via Cash, Cheque, or EFT to rppptreasurer@gmail.com*

I understand and I will pay my registration fee after receiving confirmation
I have read and agree to follow the guidelines in the RPPP Family Handbook.*

Yes
Signature: (Please Sign in box below)
Should be Empty:

25/26 After School Club Registration Application

Information of Child

Information of Parent/Guardian 1

Information of Parent/Guardian 2

Medical Information