Application For 3 Year Old Admission – 2023 New form for 2023 Registrations. Step 1 of 10 10% WelcomeThank you for your interest in Friendly Forest Preschool. To submit your application, please complete the following pages in full detail. Please use the Previous and Next buttons on each page to navigate through the form. Once your application is received, our Enrolment Team will contact you. If you experience any issues, please email email@example.com Please ensure you have the following: An image of a void cheque or a Pre-Authorized Payment form (available through most online banking institutions) Your child’s Personal Health Number An image of your child’s vaccination record You will not be able to complete the registration unless you are able to provide the above information. Alumni Family* Yes No If you have an older child who has previously attended Friendly Forest Preschool, or you yourself please check off to proceed.Registration is currently open ONLY for alumni families. Registration will open to the public on January 11th.Alumni student name* First Middle Last Please provide the first and last name of the alumni student and last year of attendance.Year Attended* Please indicate the last year of attendance at Friendly Forest Preschool.Choose ClassApplying For* 3 Year Old (Born 2020) Preferred Class* Afternoon Class 12:30- 2:45 * Time spot not guaranteed, will be confirmed by enrolment Child InformationChild's Name* First Middle Last Name Child Responds To* Sex* M F Birthdate* Month Day Year Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Language Spoken At Home* Parent/Guardian InformationName* First Last Relationship* Lives With Child* Yes No Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Cell Phone*Home PhoneWork PhonePlace of Work Hours Email* Parent/Guardian 2Name First Last Relationship Lives With Child Yes No Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Cell PhoneHome PhoneWork PhonePlace of Work Hours Email Alternative Emergency ContactsName* First Last Relationship* Phone*Lives With Child* Yes No Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Speaks English* Yes No Indicate Language Spoken* Emergency Contact 2 (optional)Name First Last Relationship PhoneLives With Child Yes No Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Speaks English Yes No Indicate Language Spoken Out Of Province Contact (Optional)Name First Last Phone Persons Authorized to Pick Up ChildOther Than Parent/GuardianNameRelationshipPhone Person Not Authorized To Pick Up ChildName First Last Relationship Procedure To Follow If Attempted AllergiesChild Has Allergies* Yes No Allergy Information*Health / Medical InformationPersonal Health Number* Doctor’s Name* Phone Number*Health ConcernsSupport Program(s), e.g. Infant Development, Kinsight, Occupational Therapist, etc.. Medications Vision / Speech / Hearing Toileting Habits Other InformationSiblings (Names And Ages) Separation Anxieties Religious Or Cultural Observances Please List Other Programs Or Activities (E.g. Daycare, Sports Etc) Parent Comments Release Of Personal InformationA class directory will be prepared by the preschool and distributed to all the families in your child’s preschool class. These directories will also be posted inside the school in the cloak room. It may not be shared outside of the preschool community and may not be used for business/services solicitation purposes. Unless otherwise stated below, I give consent for my child’s name, my name, email address, and phone numbers to be listed in the class directory.I would like to be part of the class directory* Yes No Field Trip ConsentFrom time to time we plan special events and field trips. You will be advised in advance and asked to participate in any off-premise field trips. Sometimes we leave the school area for walks in the forest or neighbourhood. When possible you will be notified ahead of time, but sometimes weather conditions or sudden opportunities may arise which may not allow time for this. On some field trips we will use public transportation with parents in attendance (e.g. visit the Port Moody Library). On others, parents will be asked to transport their own child from home directly to the field trip and from the field trip back home. I Give Permission For My Child To Be Taken On Short Trips Off The Premises, Without Prior Notice.* Yes No Washroom ConsentAlthough the preschool teachers encourage the children to help themselves with their toilet routines, it is sometimes necessary to assist those who ask for help in removing their underwear or help with zippers etc.Should my child need help with washroom routines I give permission for the preschool Teachers to assist them.* Yes No Parent Participation AgreementFriendly Forest Preschool operates as a parent participation preschool. This means that, as parents, we are responsible for both the operation and governance of the school. Accordingly, your participation is not just important – it’s essential. You are required to make a time commitment for each of the following: Clean-up Duty (Indoor or Outdoor) (1 session approx. 3 hours) Classroom Snack Duty (4 to 5 times per school year) Parent Duty Role (For more information regarding parent duties, clean-up duty opt out and security deposits please refer to the Student Handbook & Registration Guide.) I hereby agree to provide a minimum of 15 hours of my time in addition to Clean-Up and Classroom Snack Duty.* Yes Immunization Schedule And RecordThe Child Care Licensing Regulations require that children’s immunization records* are maintained. Please ensure that children’s immunizations are up-to-date and on record at the child care facility. By the start of kindergarten, children should have completed the following series of immunizations.My child is immunized* Yes No *Please note that non-immunized children will be the first to be excluded from preschool in case of an outbreak. In addition, families of non-immunized children will still be responsible for fees if they are excluded due to an outbreak.To provide Immunization records I will* Attach a scanned copy of the immunization record Write the dates immunizations were given **Diptheria, Pertussis, Tetanus, Polio, Haemophilus Influenzae Type b (HIB) Pneumococcal Hepatitis B Measles, Mumps, Rubella (MMR) Meningococcal C Chickenpox (Varicella) Influenza (optional or high risk children) Dates immunizations were given*VaccineDate (DD/MM/YYYY) Photocopy of the immunization record*Max. file size: 64 MB. Special diet (explain)Special instructions or comments for the caregiverIf the parent cannot immediately be reached, staff at the preschool can call a medical practitioner or ambulance in the case of an accident or illness of your child.I authorize the staff at the preschool to call a medical practitioner or ambulance in the case of an accident or illness of my child* Yes No Photo Release For Minors (If Under 18)I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. Friendly Forest Preschool has my permission to use my child’s image in photographs and/or video publicly to promote the preschool.* Yes No Payment I/we authorize Friendly Forest Preschool Association and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one-time payments from time to time, for payment of all charges relating to my child’s/children’s attendance at the preschool. Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the on the first day of each month. Friendly Forest Preschool Association will obtain my/our authorization for any other one-time or sporadic debits. Frequency and Amount Of Debits: A debit, in paper, electronic or other form in the amount of $215, with a reasonable latitude for adjustments and in no case to exceed $500, may be drawn on my/our specified account monthly beginning August 2023. Annual top-ups or adjustments are not permitted. If additional payments are required, such as those outlined in the “Security Deposit Agreement”, I/we agree to cooperate with the Payor to pre-authorize the processing of each and every PAD against my/our account to be authorized by use of an electronic signature. Pre-Notification Waiver: I/We agree with the Payee to waive the requirement under the CPA Rules to receive a written pre-notification prior to each PAD as set out in the Rules. This authority is to remain in effect until June 30, 2024 or when Friendly Forest Preschool Association has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting https://www.payments.ca/paying-pre-authorized-debit. Friendly Forest Preschool Association may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us. You/I/we have certain recourse rights if any debit does not comply with this agreement. For example, you/I/we have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your/my/our recourse rights, I/we may contact your/my/our financial institution or visit https://www.payments.ca/paying-pre-authorized-debit. PLEASE SUBMIT A VOID CHEQUE** If you do not use cheques, please ask for a “PRE-AUTHORIZED PAYMENT FORM” from your financial institution with the appropriate account information filled in. You can also generate a void cheque or pre-authorized payment form using online banking for most financial institutions. Attach image of a void cheque*Max. file size: 64 MB. About Security Deposit: Failure to complete your Clean-up duty will result in a withdrawal via pre-authorized debit in the amount of $100. Similarly, failure to perform your Parent Duty role each period of Sep-Dec, Jan-Mar, Apr-June will result in a withdrawal via pre-authorized debit in the amount of $200 per period up to a maximum of $600. These payments are not intended to be “fines” but rather an offset against the cost incurred. Note: Any NSF or declined PADs will be charged a fee of $30 Registration Confirmation Fee $80 Clean up Opt-out fee $150 (if opt out prior to Dec 31/2023) or $200 (if opt out after Jan 1/2024) 3 x PAD for Parent Duty fee $200 I Hereby Agree To This Pre-authorized Debit Plan* Yes Application FeeTo submit your registration application, a $80 application fee is required to be paid now.Pay With Credit Card Form Submission FeeCredit Card*Card Details Cardholder Name Please make sure your information is correct before you submit!