KIS Childcare Registration Form
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  • Kimberley Independent School Childcare Registration

    Please complete entire form. Registration Fee of $205.00 is due upon registration in order to submit your form. You will be prompted to pay by credit card at the end of the form.
  • Registration Date:
     - -
  • Program Start Date:
     - -
  • Withdraw Date:
     - -
  • Please select the programs that you are registering for. (You can select Preschool, Childcare Group Care alone or both for a combined program).*
  • Please select the type of spot that you are registering for:*
  • Documentation:

  • STUDENT INFORMATION

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  • Date of Birth:*
     - -
  • Gender:*

  • ANCESTRY (MUST BE COMPLETED):

  • Entering KIS Childcare From:*
  • Have you registered with a StrongSTART Program?*

  • PARENT/LEGAL GUARDIAN INFORMATION

  • Parent/Guardian #1:

  • Parent Type:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Will receive school emails:*
  • Lives with student:*

  • Parent/Guardian #2:

  • Parent Type:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Will receive school emails:
  • Lives with student:

  • CUSTODY (MUST BE COMPLETED):

  • Does the child reside with both parents:*
  • Is there a specific custody arrangement we should know about:*

  • **If yes, please provide a copy of the custody order to the administration.

  • EMERGENCY CONTACT INFORMATION

    Parents should notify all emergency contacts to ensure they know they are listed as an emergency contact. Please list AT LEAST ONE emergency contact that is not a parent.

  • Contact #1

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do they live locally:*
  • Do they have permission to pick-up student:*

  • Contact #2

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do they live locally:
  • Do they have permission to pick-up student:

  • Contact #3

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do they live locally:
  • Do they have permission to pick-up student:
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  • KIS Medical Information Form

  • This form must be completed for each student and you are required to contact the school administration in writing to advise if there are changes to your child's medical status or medications during the school year.
  • *** If your child does not have a regular family physician you must provide the name of the clinic or hospital where your child would go for medical care.

  • Medical History:

  • Has your child ever been subject to any of the following? Please check all that apply.
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  • Allergies:

  • Does your child have any allergies?*
  • Please include any food, medication, environmental or contact allergies they may have. Please list the specific allergy and expected potential reaction as well as any medications to be administered.
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  • Is your child's medical condition life threatening:
  • **If your child has a life threatening medical condition you must meet with the principal prior to the child attending KIS and ensure a Medical Alert Planning Form has been completed.

  • Behavior/Learning Concerns:

  • This information is an important part of determining classroom needs and resource allocation. Please provide accurate and current information regarding your child's needs so we can fully support their ability to successfully integrate into the childcare program.

    *KIS reserves the right to terminate the childcare agreement if it has been determined that a child requires a level of care or resources KIS cannot provide.

  • Does your child have any behavioral or learning concerns?*
  • Has your child been assessed by a physician or other agency for any behavioral/developmental/learning concerns?*
  • Are you willing to share the results of the assessment with KIS?*
  • Do you anticipate your child requiring increased assistance or one-on-one care?*
  • Do you currently work with, or have a referral with East Kootenay Child Supported Services?*

  • PERMISSIONS & RELEASES

  • Media Release:

  • I consent for my child's name and/or photo to be used in any external school media including classroom updates, marketing publications, webpages and social media and I understand that information posted on the internet may be stored and accessed outside of Canada.*
  • I consent for my child's name and/or photo to be used in any internal school media including the See Saw App, school yearbook, bulletin boards on the school premises and school email newsletters.*

  • Local Excursion Consent:

  • I give permission for my child to participate in out-of-school activities such as outdoor classroom activities and walking field trips within the City of Kimberley limits with the understanding KIS Board of Directors cannot assume liability for the damage of personal property or personal injury beyond normal legal responsibilities. While participating in any school excursion, students and staff are governed by all laws and regulations applying to Kimberley Independent School Society.*

  • Parent Support Group:

  • I consent for the school to disclose my name, phone number, e-mail address and child's name to the Parent Support Group (PSG) for the sole purpose of school-related communications.*
  • Date:*
     - -

  • Authorized Pick-Up List (Different from Parent/Guardians)

  • Person #1:

  • PickUp Authorized:

  • Person #2:

  • PickUp Authorized:

  • Person #3:

  • PickUp Authorized:

  • Person #4:

  • PickUp Authorized:

  • Person #5:

  • PickUp Authorized:

  • DO NOT ALLOW TO PICK UP (Please list any persons that are NOT permitted to pick up your child)

  • Indemnity Agreement

  • The undersigned hereby agrees that I am solely responsible for any liability or harm suffered by my child enrolled at Kimberley Independent School (KIS), including (without limitation) any liability or harm resulting from the negligence of KIS or any other Indemnified Person and regardless or whether such liability or harm arose on school property or during school hours, and that I WILL INDEMNIFY AND HOLD HARMLESS the Indemnified Persons from any liability for harm suffered by my child while enrolled in the School.
  • Date:*
     - -

  • Childcare Readiness Agreement

  • I/we understand that for licensing purposes my/our child is ready to start to in the childcare program and meet the requirements below regarding toilet training and naps:
    1. Be able to tell an adult that they have to use the toilet before they are actually going
    2. No longer using pull ups during the day or nap time
    3. Be able to get on and off the toilet by themselves
    4. Be able to pull down their pants and underwear and get them back up with minimal or no assistance
    5. Be able to wipe themselves properly
    6. Be able to postpone going if they must wait for someone who is in the bathroom or return to the class from an outdoor activity

  • Any child that has more than 1 toileting accident in a 2 week span will be placed on a monitoring program to determine suitability/readiness to continue with the program.

    KIS reserves the right to terminate enrollment in the childcare program if your child is determined to not meet the readiness requirements.

  • If your child has a toileting accident, the following procedure will be followed:

    • If an accident occurs a staff member will assist the child in clean up and provide a change of clothes. The parent/guardian will be notified.
    • If a second accident happens in a single day the staff will assist the child in clean-up and the parent/guardian will contacted to pick the child up promptly.
    • If a child has diarrhea, staff will assist in cleaning up the child as best as possible and the parents will be contacted for prompt pick-up. The child must stay home for at least 24 hours after diarrhea has stopped.
  • I understand that Kimberley Independent School is not mandated to provide or facilitate nap times. Childcare rooms do have daily quiet time in the afternoons and the parent/guardian will provide an appropriate blanket/pillow.
  • Date:*
     - -

  • FEE PAYMENT POLICY

  • Date:*
     - -
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  • Registration Fee Payment

    Please fill in your credit card details here for a secure payment.

  • Pay by Credit Card*

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    Childcare Registration Fee. Fee for Initial Registration into KIS Childcare Program, includes processing fee. Non-refundable.
    Childcare Registration Fee

    Fee for Initial Registration into KIS Childcare Program, includes processing fee. Non-refundable.

    $205.00 CAD$205.00CAD
      
    Total
    $0.00 CAD$0.00CAD

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