Will your child require us to administer over the counter and/ or prescription medication as or when required?

YES   NO

If Yes, please check mark the applicable box to indicate authorization to administer:

Over the counter as directed by the parents/guardian

Prescription medication as directed by a doctor.

In the event of an emergency requiring immediate medical attention, I agree to pay any expenses included in this decision.

Contact Emergency Medical Services (911) for my Child

Release information such as: child’s parents/guardian phone numbers and address, child’s emergency contact phone numbers and address, child’s immunization records, child’s Alberta Health Care, and any other information that is listed in the child’s file that will assist the emergency response personnel.

Allow Emergency Medical Services to take my child to the nearest care center to complete care for his/her injury. Because of staff to child ratios, a staff member MAY NOT be able to accompany your child in the ambulance`

I, do not consent Play PlayPlay Midnapore Daycare,to contact emergency medical services for my child due to religious, cultural, or personal reasons. The procedure I consent to is described below:

I/We (parents/guardian name(s)) authorize the release of my child and relevant information from Play PlayPlay Midnapore Daycareinto the care of emergency medical services, I/We authorize the administration of medication as defined above.



_______________________________

Parent/Guardian Signature with date

Daycare Playgrounds / Field - children will always be actively supervised by an employee.

Community Playground and Walks- children will be actively supervised by an employee.

Special Activities and Field Trips- parent/guardian will have advanced knowledge of activity.

Permission is granted to transport my child to and /or from school in a daycare authorized vehicle:

By signing below, I understand and agree to the above conditions and activities and understand and accept the risks on behalf of (child’s name).



_______________________________

Parent/Guardian Signature with date

Permission Granted for Sunscreen Lotion:

Permission Denied for Sunscreen Lotion:



Permission Granted for Insect Repellant:

Permission Denied for Insect Repellant:

I/We (parents/guardian name(s)), authorize the Transportation of (child’s name) to and/or from:

Consent: I/We hereby consent to my/our child, to avail the transportation/field trips. I/We agree to release PLAY PLAYPLAY Midnapore Daycare Children’s, Kindergarten, Summer Camp, the director, and staff members, from all liabilities for any injury, illness or accident(s) occurring during transportation/ in/out of the facility/field trip, except if such injury, illness or accident is due to gross negligence on the part of the facility staff.
The children will be transported by PLAY PLAYPLAY DAYCAREVAN/ BUS / WALK.



__________________________________
Parent/Guardian Signature with date

Furthermore, if I/We (parents/guardian name(s)) are unable to pick up our child form Play PlayPlayDaycare, the following persons have consent and are authorized to retrieve (child name) on our behalf:


(1st Person, Complete name and Relationship to the Child)

(2nd Person, Complete name and Relationship to the Child) (Optional)







_______________________________

Parent/Guardian Signature with date

I (parent’s name). give Play PlayPlay and its employees, permission to transport my child (child’s name).

to and from community parks located within Midnapore Daycare Park Community and to allow him/her to play on the playground equipment. All playground activities will be age-appropriate according to the playground equipment guidelines.

Midnapore Playground locations:

Play PlayPlay Midnapore Daycare Park:
15426 Bannister Road SE, Calgary, AB. Route to walk to the Field and Playground:
Play PlayPlay will inform parents about off-site activities through the Parents’Notice Board located by the front door.



_______________________________

Parent/Guardian Signature with date

In compliance with the Freedom of Information and Protection of Privacy (FOIP) Act, Play PlayPlayMidnapore Daycare,is requesting your consent to photos and/or videos of (child’s name).
For the following purposes:

Individual Pictures shared with other children or parents.
In-program scrapbooks/ photo albums.
Community Activities/field trips/ group pictures.

I/We, (parent and/or guardian name(s)) of (child’s name).
fully understand the above information. I voluntarily give Play PlayPlay Midnapore Daycare,consent to utilize the above checked boxes (image recordings, photographs or work) as described above. My consent is voluntary, and I reserve the right to revoke my consent at anytime. I have received a full explanation of the processes and understand and accept the risks involved

Post-Dated cheques x6 (dated first of each month)
Cash or e-transfer (paid at the beginning of each month)

NOTE:In the event that payment is returned or declined, the program will levy a $50 surcharge to cover any bank or additional costs. The overdue payment and the surcharge will be required immediately to maintain your child’s placement in the program.
NOTE:Fee’s are subject to change with one notice to the parent. Failure to do so will result in your child’s withdrawal from the months’ program.


Initial _______________________       Pre-payment/Deposit amount: $   Received Yes No
Registration fees and 50% of first month’s fee (non-refundable) will be applied to first month’s payment.

_______________________________

Parent/Guardian Signature with date

The policy of the Play PlayPlay Midnapore Daycare and Out of School Care Program will be that all children will be treated with courtesy, dignity, and respect. The methods of guidance used will be age appropriate and the emphasis will be put on self-control. We will provide a positive attitude and our expectations are that children will learn to be pro-social in their nature.

• Staff will provide guidance in a caring and supportive manner, in areas where children lack the self-control to handle situation(s) on their own.
• Children will be involved in creating the rules as to their age and abilities.
• Staff will develop the opportunity to learn to accept responsibility for one’s own behavior.
• Staff will ensure that behavior expectations and consequences for inappropriate behavior are fair, realistic, logical, and enforceable.
• Staff will remain consistent in our behavior expectations and approaches to behavior management.
• Staff will maintain control and preserve children’s privacy and self-esteem.
• Staff will maintain confidentiality when discussing a child’s behavior.
• Staff will model appropriate interpersonal and child management skills.
• Staff will maintain and insist upon acceptable standards of behavior.
• Staff will assist and help children in recognizing and learning problem solving skills.
• In cases where a child’s behavior is considered to be a serious threat to other children the following steps will be taken:

      1. All incidences will be recorded and kept in the children’s file.
      2. Parents will be required to sign an incident report.
      3. Possible 3-day suspension or expulsion if behavior continues.

• Behaviors considered a “serious threat” would include but not limited to striking other children or adults, using derogatory language in a loud abusive and continual manner, remarks, gestures or actions of a sexual nature and “taking off” from the program or from off-site trips.
• At no time will Play PlayPlay staff inflict or cause to be inflicted any form of physical restraint, confinement, isolation, physical punishment, verbal or physical degradation or emotional deprivation, denying or threatening to deny any basic necessity.
• Behavioral Expectations (rules) will be developed with the input from the children by several different means, either by informal discussions, group meetings, questionnaires, or comment box. Rules will be reviewed at the end of the year by staff, children and parents.

With respect to any child in the program, the license holder will not permit:
1) The infliction, or unreasonable cause of infliction of any form of physical punishment, verbal or physical degradation or emotional deprivation,
2) Denying or threatening to deny any basic necessity,
3) The use or permission of use of any form of physical restraint, confinement, or isolation.

ALL STAFF & PARENT’S ARE REQUIRED TO READ AND SIGN THE CHILD GUIDENCE POLICY.



_______________________________
Staff / Parent’s Signature with date

I understand that I will be required to provide one full month of written notice to the program should I terminate the care of my child. I further understand that if this notice is not provided, that I will be charged a fee equivalent to one-monthchildcare fees.

I agree to pay 50% offirst month’s fee (non- refundable) that will be applied to first month’s payment. It will be refundable if registration is cancelled within 10 days of the registration date. I understand that after 10 days, this advance fee is non-refundable.

I agree to pay full monthly fees irrespective of days missed for vacations or illness.

Aggrieved parents may appeal a decision to the Operating Committee, whose decision shall be final.

The undersigned hereby agrees to be bound by the terms as outlined in the attached Play PlayPlayMidnapore Daycare contract and/or Parent Handbook.

__________________________________________________
Signature(s) of parent(s) or guardian(s) with Date


__________________________________________________
Signature(s) of parent(s) or guardian(s) with Date


__________________________________________________
Manager/Director Signature: with Date

I have received a copy of the Parent Handbook from Play PlayPlay.

I have read the copy and understood the Polices. I agree to abide by the manual.
(child’s name).



__________________________________________________
Parent Signature with Date


__________________________________________________
Director Signature with Date