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<br />IMPORTANT: PLEASE PRINT CLEARLY and LIST THE SAME EMAILS YOU PROVIDED YOUR CHILD'S <br />SCHOOL - all registration information and EDP updates are communicated by email <br />EXTENDED DAY PROGRAM REGISTRATION FORM <br />(for 2017-2018 New Registrations only) <br />Please note: a non-refundable administrative fee of $50.00 will be charged to process each child's registration. <br />Requested Start Date: <br />School Name <br />Child's Name <br />Last NameFirst Name <br />Birthdate <br />Address <br />Home Phone Number <br />Grade Level in Sept 2017 <br />Parent/Guardian #1 <br />(first contact) <br />Last NameFirst Name <br />Home Address <br />Home Phone # <br />Cell # <br />Work Phone # <br />Primary Email <br />Parent/Guardian #2 <br />Last NameFirst Name <br />Home Address <br />Home Phone # <br />Cell # <br />Work Phone # <br />Primary Email <br />Additional Information: Please identify any needs/concerns that your child has that might require additional attention (ie. food <br />allergies, physical restrictions, etc.) in the space provided below. <br /> <br /> <br />REGISTRATION FOR DISTRICT EXTENDED DAY PROGRAM <br />My need for care is: (a minimum of 2 consistent days per week) <br /> Monday AM Tuesday AM <br /> Wednesday AM Thursday AM Friday AM <br /> Monday PM Tuesday PM Wednesday PM Thursday PM Friday PM <br />Fee information I will be responsible for the full cost of the program schedule I have indicated above <br />IMPORTANT: A signed Pre-Authorized Debit (PAD) form must accompany this form in order to process the registration. All forms can be <br />found online at <br />Subsidy information I currently receive a City of Ottawa child care subsidized space and would like to transfer it to the EDP <br />You must also register your child with the City of Ottawa Child Care Registry and Waitlist (CCRAW) <br /> <br />and select the applicable OCDSB Extended Day Program <br /> I wish to apply for a City of Ottawa subsidy <br />You must also register your child with the City of Ottawa Child Care Registry and Waitlist (CCRAW) <br /> <br />and select the applicable OCDSB Extended Day Program <br />To ensure the health and safety of my child, I/we parents/guardians of ____________________________ hereby consent to the OCDSB <br />Extended Day staff having access (through the principal) to my childs' OSR, including all medical forms/ health information. <br />Name: _________________________________________________________Date: _________________________________________ <br />I/WE the parents of ___________________________ agree to the terms of the OCDSB Extended Day Program and by signature indicate intention to <br />formally register and agree to a non-refundable registration fee. <br />Signature of Applicant <br />Date <br />CONSENT FOR THE RELEASE OF INFORMATION <br />The personal information on this form is collected under the authority of the Education Act and will be used by the Third Party Operator and the OCDSB staff for the <br />purposes of registration and enrollment in the program. Access to this information will be limited to those who have an administrative or programming need, to the <br />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 <br />questions regarding its collection, please contact the Manager, Early Learning Program, OCDSB, 133 Greenbank Road, Ottawa, ON K2H 6L3. Please keep the <br />school advised of any changes in the information as soon as possible. I understand these communications to be confidential, and the information protected and <br />not used for any purposes other than determining my Extended Day needs. <br />Signature of Applicant <br />Date <br />Please return to Early Learning Office by: email: <br />fax: 613 596-8256 phone: 613 596-8760 or use drop box in lobby at 133 Greenbank Rd. <br />