Daycare
Kindergarten
Summer Camp

REVIEWED AND REVISED JANUARY 2023

CHILD INFORMATION SHEET

Date of Birth

Start Date

Legal Gurdian YES NO

Conditions on Contact: YES NO

CHILD INFORMATION SHEET
EMERGENCY CONTACT
(No Parents)

KINDERGARTEN

Parent / Guardian Signature with Date:

Director Signature with Date:

MEDICAL INFORMATION

Unique Medical Conditions
Yes No

Specialized Medical Procedures
Yes No

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 medicines as directed by the parents/guardian.
Prescription medicines as directed by a doctor.

CONSENT THE EMERGENCY MEDICAL SERVICES

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

PARENT’S CONSENT FROM TO SHARE CHILD’S INFORMATION WITH PROFESSIONALS

In the event of an emergency medical situation, when I cannot be contacted or there is a delay in my arrival at the centre, Igrant my permission to the Program Supervisor or Senior teacher to obtain medical care for my child. I agree to reimburse the Centre for my expenses in the event of such as emergency. Play PlayPlay can share child’s specific information in an emergency. If they had to call an ambulance, they might need to share child’s specific information with the emergency medical/personal such as child’s name, Parent’s /Guardian phone numbers, and address, Child’s emergency contact phone numbers and address, child’s immunization records, child’s Alberta Health Care, allergies, and any other information that is listed in child’s file that will assist the emergency response personnel.

RECREATIONAL CONSENT AND ADVISORY

Activities: (check mark beside the activity indicates consent by parent/guardians to participate)

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.

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

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' Name

Parent / Guardian Signature with Date:

APPLICATION OF SUNCREEN LOTION & OR MOSQUITO REPELLANT
Agreement:

Permission is granted for the application of Sunscreen lotion and/or mosquito repellent on my child. Only the sunscreen and/ or insect repellant provided by the parent will be used. Please Select any one

Permission to apply Sunscreen Lotion: Yes No

Permission to apply Insect Repellant: Yes No

TRANSPORTATION/ RELEASE OF CHILD

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.

Yes we agree and authorize
We may need further discussion
No We dont authorize

Furthermore, if the parents/guardians are unable to pick up their child form Play PlayPlayDaycare, the following persons might have the consent and authorizztion to retrieve on your behalf

Transportation Authorization/ Permission Form
Daily Off-Site Activity

Consent:I give PlayPlayPlay and its employees, permission to transport my child 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.

Yes we Authorize No We dont Authorise

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.

CONSENT TO PHOTOGRAPH & VIDEO RECORDINGAGREEMENT:

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 our Child For the following purposes:

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

I/We,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

FINANICAL AGREEMENT

Play PlayPlayDaycare requires that all consents and advisories are completed prior to your child’s admission into our program. Additionally, satisfaction of the following requirements is required:

PROGRAM REGISTERED FOR:

AGE GROUP	FULL TIME	AFFORDABILLITY GRANT	PARENT PORTION
REGISTRATION FEES	$100 NON-REFUNDABLE
INFANTS (limited spaces) 12-19 Months	$ 1,450	$ 635	$ 815
TODDERS 19-3 YEARS	$ 1,350	$ 510	$ 840
PRESCHOOLERS 3 - 4 YEARS	$ 1,250	$ 450	$ 800
PRESCHOOLERS 4 – 5 YEARS	$ 1,150	$ 450	$ 700
KINDERGARTEN: Note: no part-time Kindergarten at this time	$ 1,050	$ 450	$ 600

(BREAKFAST, LUNCH SNACK INCLUDE)
*PLEASE NOTE* The one-time registration fee is non-refundable. Full deposit is due prior to starting service, regardless of attendance.

Forms of Payment:

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.
Registration fees and 50% of first month’s fee (non-refundable) will be applied to first month’s payment.

CHILD GUIDENCE POLICY

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 Signature with Date:

REGISTRATION AND IDENTIFICATION INFORMATION

Children will be released only to either registered parent or guardian. Play PlayPlayMidnapore Daycare requires written authorization or a phone call from the registered parent if the child is to be released to anyone other than the parent(s). Identification must be satisfactory before the child is released.

If a spouse is to have no contact with the child while attending the day care, a copy of the court “restraining order” must be presented to Play PlayPlay MidnaporeDaycare to be kept on file. No day care information on the child will be released to the spouse whom the “restraining order” is against.

Play PlayPlay MidnaporeDaycare does not have the right to deny access of the child to either spouse if there is no “restraining order” in effect.

Play PlayPlayMidnapore Daycare reserves the right to cancel the contract at any time if the daycare feels that it is in the best interest of the child and Centre to do so.

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.

Parent/Guardian Signature with Date:

Manager/Director Signature with Date:

PARENT HANDBOOK

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/Guardian Signature with Date:

Director Signature with Date:

Message:

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CONSENT & REGISTRATION PACKAGE PlayPlayPlay Varsity Kindergarten