Before-After School Care 2021 (non-students)

CHILD INFORMATION

Full-Name: *

First

Middle

Last

Gender: *

M
F

Date of Birth: *

Age: *

Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

First Nations: *

Yes
No

Language(s) spoken at home: *

Student is a Canadian Citizen? *

Yes
No

Birth Country, if not Canada

Please indicate:

Permanent Resident/Landed Immigrant
Temporary Resident (Please provide proof of residency status)

Proof of residency status: *

CHILDCARE INFORMATION (All fees are monthly and if you prefer a different payment arrangement, kindly indicate in the notes field at the bottom of the form.) CHILDCARE SUBSIDY AVAILABLE TO ELIGIBLE PARENTS. MONTHLY FEES DON'T INCLUDE MEALS or FOOD.

Before-After School Care Program: ($25 monthly reduction for Livingston HOA/Brookfield Communities) *

Daily 4 hours (6:30-8:30am & 3-5pm) $450 monthly
Daily 2 hours (6:30-8:30am or 3-5pm) $300 monthly

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1

Full Name: *

First

Last

Relationship to student: *

Address, same with student? (Parent 1)

Yes
No

Enter Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone: *

Email: *

Parent/Guardian 2

Full Name: *

First

Last

Relationship to student: *

Address, same with student? (Parent 2) *

Yes
No

Enter Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone: *

Email: *

EMERGENCY CONTACT (Does not include one of the parents)

Full Name: *

First

Last

Phone: *

Email: *

ADDITIONAL INFORMATION

Any form of allergies that we need to be aware of (please list or specify): *

Is your child on routine medication that must be taken at the daycare? *

Yes
No

If yes, please explain: (routine medication)

Immunization up-to-date? *

Yes
No

If no, please explain: (immunization) *

Do you believe your child is showing symptoms of developmental delays? *

Yes
No

If yes, please explain and include any intervention/support done in the past:

TERMS AND CONDITIONS

I understand that monthly fees will be debited from my account every 1st of the month and will abide to this year’s contract. For unforeseen events that my child is required to be transferred to another before-after school care I agree to give a month’s notice by the 1st of the month in writing. It will be the programs decision to honor my request on a case to case basis. Notice given after the 1st of the month will result in full fees for the next calendar month.
It is my responsibility to inform the before-after school care for any changes to our address, phone numbers (home & work) emergency contacts, or anything that maybe important concerning the well-being of my child (i.e. illness/death in the family, divorce or separation etc.)
It is my responsibility to inform the before-after school care daily (school app) if my child is sick until the child returns to school and to keep my child at home if showing symptoms of vomiting, has a fever or diarrhea, or has an excessive cough, or anything contagious like “pink eye”.
It is my responsibility to inform the before-after care if my child is expected to be away for longer than 3 days at any time. NO refunds for absences or extended leaves (i.e. vacations).
I give permission for the staff at Calgary International Academy Childcare to treat my child for minor injuries (i.e. first aid) and to call for appropriate medical support (ambulance, poison control, etc.) in case of serious injuries that requires immediate care and hospitalization.
A charge of $50CAD for NSF payments per transaction and payments in default may result in cancellation of services.
I authorize the before-after care to use my child’s pictures, videos or any form of media for promotional purposes.

I agree to the terms of this contract, including the 2021 Fees Policy and Parent’s Handbook/Policies and Procedures.

Non-refundable registration fee: *

New $100
Returning $50

Upload voided cheque: (monthly fees and registration fee) *

Notes: