HomeMy WebLinkAboutOCDSB 225 Extended Day ELP Registration July 2010
Extended Day Program – Child Registration
(Please complete a separate registration form for each child)
Applicant/Parent/Guardian:
This registration form consists of three parts:
Part A – Program Information
Part B – Registration
Part C – Child and Family Information
Carefully review the information in this form regarding the Extended Day Program offered by the Ottawa-
Carleton District School Board. Upon review,
(i) complete the form answering all questions noted below;
(ii) provide a deposit in the amount of $100.00; and
Friday, July 21
(iii) return the completed form and deposit by to: Ms. Eleanor Heap
Manager, Early Learning Program
Ottawa-Carleton District School Board
440 Albert Street
Ottawa, ON K1R 5B5
IT IS IMPORTANT YOU DO NOT DISCONTINUE YOUR CURRENT CHILD CARE ARRANGEMENTS PRIOR
TO RECEIPT OF CONFIRMATION AND ACCEPTANCE IN THE OCDSB EXTENDED DAY PROGRAM.
THIS
WILL BE PROVIDED IN WRITING WITHIN ONE WEEK OF RECEIPT OF THIS APPLICATION FORM.
PART A – PROGRAM INFORMATION
Program Availability
The Extended Day Program is open to children registered in the host school who are four or five years
old as of December 31, 2010.
Days / Hours of Operation / Staffing
The Ottawa-Carleton District School Board will operate on all regular school days with the ability to
select one of the following options.
Morning program: 7:00 a.m. to the start of the school day (Daily fee based on site)
Afternoon program: End of the school day until 6:00 p.m. (Daily fee based on site)
Both morning and afternoon ($23.30 per month set fee)
Parents/guardians may register their child in the morning, afternoon or both programs. The program
is currently not offered during statutory / school holidays or on PA days. However, we are hoping to
provide access to the program on PA days, to be confirmed at a later date.
The program will be staffed with one registered Early Childhood Educator and child care assistants to
meet a ratio of one (1) adult for thirteen (13) students.
Withdrawal
The OCDSB requires written notice 30 days in advance prior to the withdrawal of your child from the
program.
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OCDSB 225 Planning (July 2010)
Extended Day Program – Child Registration
Privacy
By providing personal information to the OCDSB Extended Day Program, you agree and consent to
the collection, use and/or disclosure of such information by the OCDSB for the purposes of registering
and providing the extended day program for your child at the school facility.
PART B – REGISTRATION
Program Choice
Check the relevant option you are registering for:
School Name / Location: ____________________________________________________
Morning (7:00 a.m. until start of school day) (Daily fee to be determined based on site)
Afternoon (end of school day until 6:00 p.m.)(Daily fee to be determined based on site)
Both morning and afternoon ($23.30 per month set fee)
Yes, if space is available, I would be interested in registering the following additional child(ren)
for the same program at this location: This option is available to a limited number of grade 1
and 2 students. You will be notified at the time of enrollment confirmation if space will allow for
additional registrations.
Name: Grade/Age:
Name: Grade/Age:
Registration Fee and Payment
Fees must be paid on a monthly basis in advance. A deposit in the amount of $100.00 is required
with this registration form. This deposit will be deducted from your first monthly fee.
Payment options include:
Money order (payable to the Ottawa-Carleton District School Board)
Cheque (payable to the Ottawa-Carleton District School Board)
Credit Card (Visa or Mastercard)
Card Type: Card Number:
Expiry Date: Month Year Cardholder Name:
Cardholder Signature:
Parents/guardians will receive a tax deductible receipt for all fees paid.
Contact Eleanor Heap, Manager, Early Learning Program, at eleanor.heap@ocdsb.ca if you are
experiencing financial hardship and would like to discuss the registration requirements and fee.
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OCDSB 225 Planning (July 2010)
Extended Day Program – Child Registration
Child Care Subsidy
Extended Program fees are the responsibility of the parents/guardians. Subsidies may be available to
qualifying families living in Ottawa, based on financial need.
Yes, I currently receive a City of Ottawa child care subsidized space at the following
facility:
_____________________________________________________________________________
(Name of current child care provider / facility)
No, I do not currently receive a City of Ottawa child care subsidized space but I will be
applying to the City for a subsidy.
No, I do not currently receive a City of Ottawa child care subsidized space and will be
responsible for the costs of the extended day program fees.
Further subsidy information can be found on our website at
http://www.ocdsb.edu.on.ca/au_hi_kindergarten-ELP.asp or by contacting the Manager, ELP.
PART C – CHILD AND FAMILY INFORMATION
CHILD’S INFORMATION
Surname: Given Name(s):
Address: Sex: Male Female
Date of Birth:
Postal Code: Application Date:
Requested
Telephone: Entry Date:
School: Grade / Age:
Siblings in
the school: Grade / Age:
Priority for Registration
(if registering more than one child ages 4 to 5):
FAMILY INFORMATION
PARENT / GUARDIAN 1
Surname: Given Name(s):
Address:
(if different Relationship to
from child) Child:
Employer::
Telephone: (w) Telephone (h):
Cell number: Primary e-mail:
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OCDSB 225 Planning (July 2010)
PARENT / GUARDIAN 2
Surname: Given Name(s):
Address:
(if different Relationship to
from child) Child:
Employer::
Telephone: (w) Telephone (h):
Cell number: Primary e-mail:
Child lives with: Both parents Father Mother
Step father Step Mother Guardian
Check if applicable: Father deceased Mother deceased Parents divorced or
separated
Joint custody Mother has custody Father has custody
Are there any special custodial arrangements?
EMERGENCY CONTACT PERSON (
If other than a parent)
Name: Relationship:
Telephone (w) Telephone: (h)
Cell number: Other:
CHILD’S MEDICAL INFORMATION
Doctor’s Address:
Name:
Telephone (w) OHIP # (optional):
Allergies: Medications::
Medical
Conditions:
To ensure the health and safety of my child, I/we, parents/guardians of _______________________, hereby
consent to the OCDSB Extended Day staff to access my child’s OSR (through the school principal), including all
medical forms and health information that are on file in the _________________________________ school.
Dated: _________________________________.
Name: Signature:
Name: Signature:
I/we, the parents/guardians of _____________________________ have read, understand and agree to terms of
the OCDSB Extended Day program as outlined above and by signing below declare we wish to register our
child in the Extended Day program at _________________________________________ .
\[I
ndicate school name\]
Name of Parent/Guardian
Signature
Name of Parent/Guardian
Signature
Dated
The personal information on this form is collected under the authority of the Education Act and will be used by the extended day / OCDSB staff for the purposes
of registering and enrollment in the program. Access to this information will be limited to those who have an administrative or programming need, to the student
to whom the information relates and the parent(s) / guardian (s) of a student who is under 18 years of age. If you wish to review this information or have
questions regarding its collection, please contact the Manager, Early Learning Program, OCDSB, 133 Greenbank Road, Ottawa, ON K2H 6L3. Please keep
the school advised of any changes in the information as soon as possible. Confidential When Complete.
Distribution:
Original – Manager, Early Learning Program
Copy – Parent/Guardian
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OCDSB 225 Planning (July 2010)