Name: Victoria Day (Stat) – CLOSED Kitimat & Terrace
Start: 2023-05-22T00:00:00+00:00
End: 2023-05-22T23:59:59+00:00

Child Information

Child's Name *

First

Middle

Last

Child's Birthdate *

Sex *

Male
Female

Child's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

School that the child is or will be attending *

Parent/Guardian Information:

Child's Parent/Guardian #1 *

First

Last

Contact Number *

Alternate Contact Number

Parent/Guardian #1 Address (If different from child)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian #1 Occupation *

Parent/Guardian #1 Place of Employment *

Parent/Guardian #1 Work Phone Number *

Email of Primary Parent/Guardian *

Child's Parent/Guardian #2

First

Last

#2 Contact Number

#2 Alternate Contact Number

Parent/Guardian #2 Address (If different from child)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian #2 Occupation

Parent/Guardian #2 Place of Employment

Parent/Guardian #1 Work Phone Number

Other people to notify in case of emergency:

(Other than parent)

Name of Person to notify in case of Emergency *

First

Last

Contact Number *

Alternate Contact Number

Name of Person#2 to notify in case of Emergency

First

Last

Contact Number 2

Alternate Contact Number 2

Who has permission to pick up your child?

(Other than parent) Will be asked for a valid ID upon arrival at the centre

Name as it appears on ID of person allowed to pick up your child

First

Last

Contact Number

Alternate Contact Number

Who does NOT have permission to pick up your child?

Name of person who does NOT have permission to pick up your child

First

Last

Reason

Child Health Information

Child Personal Health Number *

Immunizations up to date *

Yes
No

Physician *

Physician's Phone

Dentist *

Dentist's Phone

Special Health Problems

Allergies

Please include reaction

Distinguishing Marks

(large birthmarks, moles, etc.)

Regular Medications

Please include reaction

Custody/Parenting Time Notes (if applicable)

Additional Information

CONSENT TO MEDICAL CARE AND TREATMENT OF A MINOR CHILD

I understand that the policy of Coast Mountain Children Society is to notify a child’s parent or guardian in the event a child becomes ill or injured while being cared for. Occasionally parents cannot be reached but immediate help is required for a child. If my child, ___ is injured or becomes ill and I am not available, I hereby give authorization for staff of Coast Mountain Children Society to seek medical attention. I also authorize the administration of emergency medical procedures deemed necessary by the doctor. IN AN EMERGENCY I agree that Coast Mountain Children Society may call an ambulance to take my child to the nearest hospital.

Childs Name *

First

Last

Today's Date *

Parent Name *

First

Last

Signature *

TRANSPORT CONSENT

• I give permission for my child to be transported by Coast Mountain Children Society authorized business vehicles as transportation for field trips or pick up to and from school.

• I give permission for the staff of Coast Mountain Children Society to apply child safe sunscreen and child safe bug repellant as deemed necessary by staff.

• I give permission for staff to take pictures of my child to be used at the Centre for the enjoyment of children, families, and staff. We will request written permission if we want to use the photos of your child for other purposes.

FEILD TRIP CONSENT

• An integral part of our program is planning for experiences and activities outside the Centre. If possible, parents/guardians will be informed in advance and a written permission slip will be provided, outlining our plans.

• I give permission for my child to participate in spontaneous walking trips with the care provider, as long as information on location is posted on childcare centers door. I also, give permission for my child to use off site playgrounds as defined in parent handbook. I understand I will be notified in advance.

POOL CONSENT

• I give permission for my child to play in a (less than 1.5 foot) pool, while attending Coast Mountain Children Society. There will be no more than five children in the pool at one time, this will also depend on children’s size and comfort level while in pool. I understand that children will be closely supervised.

• I understand the pool water status will be continually observed (pool will be shocked with ½ tsp of chlorine at the end of each day). And water changed no less than every two days.

By signing this form, I have agreed to the terms outlined in the Care Arrangement/Consent Guidelines, Field Trip Consent, and Pool Consent

Childs Name *

First

Last

Today's Date *

Parent Name *

First

Last

Signature *

CARE ARRANGEMENT CONSENT

• I will not send my child to daycare if my child is ill and I will notify childcare provider if child is contiguous. I will not send my child to daycare if my child has any sign of lice.

• In the event of an outing, I understand the 18-passenger school bus with Class 4 licensed driver, and clear abstract will be used. In the event of a smaller outing or transportation need I understand that an alternative business vehicle may be used.

• All children not yet 9 years old will be restrained in a car seat/booster seat dependent on the Motor Vehicle Act and ICBC recommendations. The care provider will have a valid driver’s License. I understand in the bus a car seat/booster seat is not used as defined by the Motor Vehicle Act and ICBC recommendations.

• I give permission for my child to be transported by Coast Mountain Children Society if driver holds a valid driver license, with applicable Classification, and clear drivers abstract. Also, that there is additional liability insurance for the use of the vehicle for this purpose.

By signing this form, I have agreed to the terms outlined in the Transportation Consent

Childs Name *

First

Last

Today's Date *

Parent Name *

First

Last

Signature *

PLEASE READ THE BELOW INFORMATION VERY CAREFULLY AS YOU ARE AGREEING TO ALL OF THE BELOW TERMS WHEN YOU SIGN THIS AGREEMENT

• All programs are a monthly rate and families will be charged their monthly rate as per the signed agreement regardless of child’s attendance until the contract has been terminated as per our termination policies. No reductions, substitutions or credits are given for scheduled days that fall on statutory holidays.

• Childcare fees are due on the first of the month as per your PAD agreement or post dated cheques. Unpaid childcare fees cannot exceed one month, if this occurs immediate termination of care will be at the discretion of manager.

• A late pickup fee of $20 will be charged per child per 15-minute intervals past the maximum time allowed of 9 hours or 5:15 PM, whichever is greater.

• Failure to notify the centre of your child not needing after school pickup will result in a $25 charge. After 3 failures to notify your child may be removed from care at management’s discretion.

• All NSF checks will be subject to a one-time charge, per cheque of $65.00.

• If the Parent/Guardian becomes ineligible for the Childcare Affordable Care Benefit they will be responsible for paying the full monthly fee. It is the Parent/Guardian’s responsibility to keep all information (i.e.: relationship status, work/school status, family income, reason for care, address, phone number, court orders, custody arrangements etc.) current with the Affordable Childcare Benefit Branch and CMCS.

• Parent(s) are responsible for the parent portion of fees that is not covered by the Affordable Child Care Benefit. If parents wish to start their child before the Affordable Child Care Benefit is approved, payment for the month will be required. The parent will be credited on their next monthly bill when the benefit is received.

• The childcare arrangement for the school age and community preschool program may only be terminated on certain dates:

September – December 2020 – can be terminated on or before August 1, 2020.

January – March 2021 – can be terminated on or before December 1, 2020.

April – June 2021 – can be terminated on or before March 1, 2021

By signing this form, I have agreed to the terms outlined above and I agree to the fees as checked off below. The parent or guardian agrees to place the child in Coast Mountain Children Society located at 4620 Loen Ave Terrace BC. The parent or guardian and CMCS - Terrace agree that childcare services will be available for the child as indicated on the enrollment form.

Monthly Fees *

2020/2021 School Year Kindergarten $440 (less the BC Gov parent fee reduction of $100) $340 per month
2020/2021 School Year Grade 1-6 $440 per month

One Time and Annual Fees *

One Time Registration Fee (First time students only)- $25
Annual Insurance Fee - $25
Annual Bussing Fee (Uplands, Ecole Mtnview & Cassie Hall) - $25

Parent Name *

First

Last

Signature *

Registration Fee – All Programs	$25.00 Per Child – One-time fee per child
Annual Insurance Fee – All Programs	$25.00 Per Child – Billed September 1st yearly per child

Program	Half day (4hrs) (after reduction)	Full Day (4hrs+) (after reduction)	Monthly Rate (after reduction)
Infant/Toddler Program 0-36 Months Monthly rate only	N/A	N/A	$1325.00 ($975)
Group 3-5 Program	$31.25 ($28.75)	$48.75 ($43.75)	$975.00 ($875)
ALL AGES: Drop In (no ½ day)	N/A	$65.00 (no reduction)	N/A
Group 3-5 – 2 Full Days/week	N/A	N/A	$400.00 ($360)
Group 3-5 – 3 Full Days/week	N/A	N/A	$600.00 ($540)
Group 3-5 – 4 Full Days/Week	N/A	N/A	$780.00 ($700)
Group 3-5 – 2 Half Days/week			$250.00 ($230)
Group 3-5 – 3 Half Days/week			$345.00 ($345)
Group3-5 – 4 Half Days/week			$500.00 ($460)
Group 3-5 – 5 Half Days/week			$625.00 ($575)

Program 8:00am-12:00pm	Monthly Rate
Monday/Tuesday/Wednesday/Thursday/Friday	$500.00
Monday/Wednesday/Friday	$300.00
Tuesday/Thursday	$200.00

Program	Monthly Fee
September 2021 – June 2022 Kindergarten	$465.00($415.00) parent fee reduction of $50 applied
September 2021 – June 2022	$465.00
Spring Break 2022 Optional Week	$200.00
Summer Program – July & August 2022	$950.00 per month
Additional Weeks – June 27-30 2022 & August 29 – September 2, 2022	$180 per week

Victoria Day (Stat) – CLOSED Kitimat & Terrace

May 22

Details