Preschool & Afterschool Registration - Delbrook Wonderland Academy

PARENT/GUARDIAN AND PRE-AUTHORIZED CONTACT PERSONS INFORMATION
Delbrook Wonderland Academy requires detailed information for all persons from parents / guardians with legal custody of the child, to other authorized persons by the parents or legal guardians regarding Child Pick-Up safety policies and procedures. The required personal information is confidential and only be available to educators and staff of Delbrook Wonderland Academy, and appropriate licensing and law enforcement authorities up request.

1. If parents are separated, divorced or otherwise estranged then a copy of a court order or other legal document detailing custodial arrangements must be supplied to Delbrook Wonderland Academy.

2. If the custody of the child is with anyone other than biological or adopted parent(s) of the child, then copies of the proper documentation must be provided to Delbrook Wonderland Academy.
Parent's Marital Status*
- Married
- Divorced
- Separated
Child mainly reside with*
Is there a custody agreement?
Accepted file types: doc, docx, pdf, jpg, jpeg, png, Max. file size: 10 MB.
If so, please attach your legal documents
EMERGENCY CONTACT INFORMATION
Name*
Relationship*
Contact*

Phone Number and Other Contact Information
Name
Relationship
Contact

Phone Number and Other Contact Information
Name
Relationship
Contact

Phone Number and Other Contact Information
I AUTHORIZE THE FOLLOWING PEOPLE TO REMOVE MY CHILD FROM DELBROOK WONDERLAND ACADEMY OUT OF SCHOOL CARE PROGRAM:
Name
Relationship
Contact

Phone Number and Other Contact Information
Name
Relationship
Contact

Phone Number and Other Contact Information
Name
Relationship
Contact

Phone Number and Other Contact Information
Signature
Restricted Person
If there is person who is legally restricted or forbidden from being in contact with your child, or taking your child from our center, please provide their information. If this person arrives at our center, he/she will be asked to leave and the police will be notified.
Would you like to add someone to the restricted person's list?
Please Attach Picture of This Person
Accepted file types: doc, docx, pdf, jpg, jpeg, png, Max. file size: 10 MB.
Name
First Last
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Other details
Does he/she have a criminal record?
- Yes
- No
Is there an active restraining order against this person?
- Yes
- No

Little Rascals Delbrrok (Preschool & Afterschool) is managed by Little Pioneer Academy Ltd.. The use of the name “Little Rascals Delbrook (Preschool & Afterschool)” or any of the above variations on the name “Little Rascals Delbrook” in this agreement shall be understood to mean Little Pioneer Academy Ltd..
Consent*
I , the undersigned, do hereby acknowledge that I am the legal custodial parent/guardian of the child.
With all rights at law to enroll my child in a Delbrook Wonderland Academy program, and I acknowledge and agree with all of the following terms:

Center Policies and Procedures Agreements:

1. I have received, read and understand the Delbrook Wonderland Academy (Preschool & Afterschool) Parent Handbook and I do agree with and follow the policies, procuresses and conditions in the handbook while my child(ren) is enrolled
2. I agree with the Active Play Policies and give permission to Delbrook Wonderland Academy to take my child(ren) for outdoor play at least 30 minutes per day regardless the weather and I will provide weather appropriate clothing for their children each day.
3. I have received, carefully read and understand the Registration Form (1-4) including Agreement for Child Care Service and I do agree with the policies, procedures and conditions stated herein;
4. I understand that the Delbrook Wonderland Academy (Preschool & Afterschool) has the right to terminate service to my family if I am in breach of this contract;
5. I have made full disclosure to Delbrook Wonderland Academy in terms of medical/ health conditions or issues pertaining to my child as requested or indicated in the registration form.
6. I have made a full disclosure to Delbrook Wonderland Academy in writing of a physical condition, special needs, challenges or disabilities that affect my child;
7. I understand that with respect to Supported Childcare (special needs care), Delbrook Wonderland Academy (Preschool & Afterschool) will discuss with parents or guardians to work out a plan first to meet the child’s needs. If intervention is necessary it is not the responsibility of the Delbrook Wonderland Academy to hire staff for the purpose of providing Supported Childcare but rather the responsibility of the parent/guardian to coordinate this with the appropriate
government agency. Delbrook Wonderland Academy (Preschool & Afterschool) will help parents or guardians to find resources in such case.

Safety, Health and Medication Agreements:

8. I have provide correct and full information through the Delbrook Wonderland Academy (Preschool & Afterschool) Registration Form (1-4), and attached copies of all necessary information that Delbrook Wonderland Academy (Preschool & Afterschool) Staff should be aware of in order for Delbrook Wonderland Academy (Preschool & Afterschool) staff to properly and safely provide safe and quality care for my child and the other children in Delbrook Wonderland Academy childcare program(s).
9. I agree that parents or guardians must provide correct copy of medication instruction to the Delbrook Wonderland Academy staff when my child requires medication administration and they are not responsible for the child’s reactions to the medication. The damage of the medication is at parent’s cost.

10.I give consent to Delbrook Wonderland Academy staff to consult with the Public Health nurse if necessary and in the case of emergency to call a qualified physician, family doctor, or ambulance.
11.I agree with the Sick Child Policies in the Delbrook Wonderland Academy Parents Handbook and will notify the center if my child is sick or contrasts to anything contagious within 24 hours to ensure the wellbeing and safety of all families and staff at the center.
12. I acknowledge that Delbrook Wonderland Academy in consideration of promoting safe and healthy childcare service and operation, may make changes to its information packet, childcare Brochures, Admission Guide, Registration Policy and Forms, Parent Handbook, Website Information, Curriculum of childcare programs, center policy and procedure manual and etc..
13. I hereby give permission to Delbrook Wonderland Academy for my child to attend all walking field trip while enrolled in Delbrook Wonderland Academy childcare program(s). If it is a field trip requires transportation, and I will follow the Field Trips Policies in Parent Handbook. I will sign the Field Trips Consent Form to give the permission to Delbrook Wonderland Academy for my child to attend major field trips.
14. I will notify the center if my child is absent from the center.
15.In consideration of children’s health and safety, Delbrook Wonderland Academy educators are not allowed to provide any form of childcare out of the center. Parent/guardian agree to take all responsibility if asking an educator to provide any form of childcare out of the center without permission of the Director of Delbrook Wonderland Academy.
Fees and Payment Agreements:
16. I agree to pay my child’s fee while enrolled in Delbrook Wonderland Academy following Fees and Payment Policies issued in the Parent Handbook, on or before the first day of that month. Late payment will be charged $25 and NSF cheques will be charged $30.
17. I agree to pay additional fees (e.g. Late Pick Up Fee or Spring Break) stated in the Delbrook Wonderland Academy Parent Handbook if applicable. Payment will be made by cheque or etransfer.
18 .Delbrook Wonderland Academy reserves rights to change its fees in terms of providing better service for children and families. Notice will be given and posted at least one month in advance of any such change.
19. I agree that if my child is unable to attend the enrolled program due to illness or holidays, I will pay the full fee to keep the enrollment for my child.
20. One month’s fee is paid as Deposit to Delbrook Wonderland Academy for enrollment. The deposit will not be returned for non-compliance of this contract. The deposit will not be fully refunded if there is delayed payment subjected to any additional fees in the Delbrook Wonderland Academy Parent Handbook. The deposit is applicable to the last month fee for client who has no delayed payment or be fully refunded before the last day of the last month.
21. Two Months written notice in advance is required when withdrawing you child from our Delbrook Wonderland Academy The deposit will not be refunded if there is failure of giving proper notice.
22. I have read the Delbrook Wonderland Academy Parent Handbook and agree with the Termination of Service polices. I understand the Delbrook Wonderland Academy reserves the right to refuse service to clients who do not follow center policies for the safety and healthy consideration of the other students and staff, as well as center operation.
Please print child’s full name as shown in the registration form*
Date*
MM slash DD slash YYYY
Parent's Signature*

Registration Form

Child's Information

Parent / Guardian Contact Information #1

Parent / Guardian Contact Information #2

Language Spoken at Home

PARENT/GUARDIAN AND PRE-AUTHORIZED CONTACT PERSONS INFORMATION

EMERGENCY CONTACT INFORMATION

I AUTHORIZE THE FOLLOWING PEOPLE TO REMOVE MY CHILD FROM DELBROOK WONDERLAND ACADEMY OUT OF SCHOOL CARE PROGRAM:

Restricted Person

Child Health Information

Medical Conditions

If your child has allergies or food sensitivities, indicate which foods/allergens and the strength of the reaction

Medication

Delbrook Wonderland Academy

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