5212 50 Street
Leduc, AB T9E 6Z6
780-739-JILL (5455)
www.jackandjillplayschool.weebly.com
[email protected]
Dear Parents and Guardians,
Please complete the attached form including the $100.00 non-refundable Registration Fee and all
post-dated cheques and bring it to the Playschool on January 25th, 2017 for Registration Night.
The doors will be open from 6:00pm to 8:00 pm and you will be able to see the class room, meet the
teacher and get any help with the forms that you may require. Registration is on a first come first
serve basis but time will be given to help with the forms.
***Returning students and their siblings receive $50 off their registration fee! Must register by
January 25.***
Types of Preschool Programs:
1. 3 YEAR OLDS- Two Day per week
 Must be 3 by Oct.1, 2017 (2 yr olds must be parented until 3rd birthday)
 Tuesday & Thursday:
o Mornings (9:00 am - 11:30 am) or
o Afternoons (12:15 pm – 2:45 pm)
2. 4 YEAR OLDS- Three Days per week
 New students must be 4 by Dec.31, 2017 (younger students from the 3 yr old
program are exempt)
 Monday, Wednesday & Friday:
o Mornings (9:00 am - 11:30 am) or
o Afternoons (12:15 pm – 2:45 pm)
***IMPORTANT NOTICES***
*The $100 non-refundable registration cheque and all post-dated tuition cheques are due at
the time of registration. There should be 14 cheques.
*The Criminal Records Check and Child Intervention Checks are required by the parent/family
representative who will roster at Jack and Jill Playschool. These checks must be received by
the registrar by August 15, 2017!
Approved January 5, 2017
New 2017/2018 Fee Schedules
**** Jack and Jill Playschool now offers the option to pay an extra fee of $50/month if you do not wish
to or are unable to roster. A teacher’s assistant will replace your shifts. Please ad $50/month to your
post-dated cheques if you are choosing this option*****
3 Year Old Program Post-Dated Cheque Schedule
September 1st Cheque
- $200.00 (covers first and last month’s registration
fees)
8 Monthly Class Fee Cheques
- October 1st to May 1st - $100.00 each
$100
$200
$50
$75 EACH
1 Registration Cheque- due at time of registration1 UNDATED Roster Commitment Cheque –
1 UNDATED Toy Cleaning Commitment Cheque 2 UNDATED Fundraising Commitment Cheque***These 4 cheques will only be cashed if commitments are not met
*There should be 14 cheques (note registration fee $50 for returning students and siblings)
4 Year Old Program Post-Dated Cheque Schedule
September 1st Cheque
- $250 (covers first and last month’s registration fees)
8 Monthly Class Fee Cheques
- October 1st to May 1st - $125.00 each
1 Registration Cheque- due at time of registration1 UNDATED Roster Commitment Cheque 1 UNDATED Toy Cleaning Commitment Cheque 2 UNDATED Fundraiser Cheques ***These 4 cheques will only be cashed if commitments are not met
$100
$200
$50
$75 EACH
*There should be 14 cheques (note registration fee $50 for returning students and siblings)
Please read through our information package (also available online on
our website www.jackandjillplayschool.weebly.com) for all information
regarding Fees, Rostering duties, Toy Cleaning commitment,
Fundraising, NSFs, Procedures & Policies etc…
Approved January 5, 2017
REGISTRATION FORM:
The 2017-2018 school year runs from September 2017 – June, 2018 following the Black Gold School
Division School calendar. The school is closed for statutory holidays, Christmas and March Break and
runs for approximately 38 weeks. There will be a Parent Night to be announced the first week of
September. School supply lists will be emailed out in August. Please check preferred class. PLEASE
HAVE ALL INFORMATION FILLED OUT IN FULL – Incomplete Registrations will not be accepted.
Child’s Name: ___________________________
Class
Time
Date of Birth (M/D/Y):_______________
Days of School
Monthly
Tuition
3YR AM ____
9-11:30am
Tues/Thurs
$100.00
3YR PM ____
12:15-2:45pm
Tues/Thurs
$100.00
4YR AM ____
9-11:30am
Mon/Wed/Fri
$125.00
4YR PM ____
12:15-2:45pm
Mon/Wed/Fri
$125.00
Special Points of Interest:
-
The preschool is run by a board of parent volunteers. These members include: president, vicepresident, secretary/special events planner, treasurer, fundraiser, registrar and our teacher. The
board meets once a month and is open to all parents.
Would you consider a position on our board?
Yes______ No______
-
We are a non-profit organization that relies on student fees and fundraising to operate. Each
child is required to fundraise $150 of profit for the school year. You may opt to pay out this
amount and not fundraise.
-
Toy cleaning is done one evening a month at the playschool and parents are required to do this
once each year. You may opt to pay out your toy cleaning cheque if you cannot participate ($50).
-
We have a Facebook page for families only that we use to communicate class information. It is
also a valuable way for parents to communicate with each other. Please provide an email address
that is connected to Facebook so we can search for you and ad you to the page.
Approved January 5, 2017
Jack and Jill Playschool Enrolment Form
Name of Child:_____________________ Preferred Name:____________________
Birthday (m/d/y)____________________
Male or Female:______________________
Address: ________________________________________________________________
City:______________________________
Province:____________________________
Postal Code: ________________________
*Potty Trained (by Sep.1)_________________
Mother’s Name:_____________________
Lives with child?________________________
Cell Phone:__________________________
Home Phone:___________________________
Address:__________________________________________________________________
City:_______________________________
Province:_____________________________
Postal Code:__________________________ Employer:_____________________________
Work Address:_____________________________________________________________
City:________________________________ Work Phone:___________________________
***Email:_____________________________Use this email for school facebook page?______
Father’s Name:_______________________ Lives with Child?________________________
Cell Phone:__________________________
Home Phone:___________________________
Address:__________________________________________________________________
City:_______________________________
Province:_____________________________
Postal Code:__________________________ Employer:_____________________________
Work Address:_____________________________________________________________
City:________________________________ Work Phone:___________________________
***Email:____________________________ Use this email for school facebook page?______
Person(s) authorized to pick up child (including parent(s)/guardian(s)). Your child will not be
released to anyone not on this list without written/verbal comfirmations (picture ID required):
Name (First/Last): _____________________ Relationship to Child:____________________
Name (First/Last): _____________________ Relationship to Child:____________________
Name (First/Last): _____________________ Relationship to Child:____________________
Name (First/Last): _____________________ Relationship to Child:____________________
Who child cannot be released to:________________________________________________
Signature of Parent/Guardian:_________________________________________________
Approved January 5, 2017
Jack and Jill Playschool Emergency Consent Form
Name of Child:___________________
Preferred Name:____________________
Birthday (m/d/y)_____________________
Male or Female:________________________
Address: _________________________________________________________________
City:______________________________
Province:_____________________________
Postal Code: ________________________
Home Phone:___________________________
Emergency Contact #1 (Other then parent/guardian)
Name:_____________________________
Relationship to Child:____________________
Home Phone:________________ Cell Phone:______________ Work Phone:______________
Address:__________________________________________________________________
City_____________________ Province:_____________ Postal Code:__________________
Emergency Contact #2 (Other then parent/guardian)
Name:_____________________________
Relationship to Child:____________________
Home Phone:________________ Cell Phone:______________ Work Phone:______________
Address:__________________________________________________________________
City_____________________ Province:_____________ Postal Code:__________________
Family Dr._________________________
Phone Number:_________________________
Address:__________________________________________________________________
City:_____________________________
Provice:______________________________
Alberta Health Care #:________________________ Immunizations up to date?___________
Any allergies, medical consitions or dietary restrictions we should be aware of:______________
_________________________________________________________________________
What step are to be taken in case of an allergic reaction (medications)?___________________
_________________________________________________________________________
Previous History of Communicable Disease: (ex. chicken pox): ___________________________
_________________________________________________________________________
Child’s typical reaction when he/she is stressed/ill:__________________________________
_________________________________________________________________________
Any particular fears/sensitivities (thunder, dark, animals etc)? _________________________
Approved January 5, 2017
EMERGENCY CONSENT FORM – Jack & Jill Playschool Continued
Legal Waiver
It is the policy of Jack & Jill Playschool to notify the parent/guardian/emergency contact when a child
is ill or needs medical attention. Should we not be able to contact parent, guardian or emergency
contacts and immediate medical assistance is required for the child, our procedure is the have the child
transported to the nearest emergency service. By signing the consent below, you consent us to:
1) Take appropriate action on behalf of your child. This includes that in the case of a medical
emergency, appropriate first aid trained personnel will administer first aid to your child.
2) If necessary, an ambulance will be provided at your cost, for the transportation of your child to the
hospital. Jack and Jill Playschool will not be held liable in the event of a medical emergency, should your
child not receive adequate attention once he/she has left the school grounds.
3) I hereby give consent for my child, ___________________________ when ill or injured to be
transported to the nearest emergency centre when I, or my appointed emergency contacts cannot be
reached.
4) I hereby give consent for my child ____________________________ to receive emergency
medical treatment.
5) I understand I will be notified of all injuries sustained while on school property and complete the
necessary incident report required by Licensing.
Signature of Parent/Guardian
Approved January 5, 2017
Print Name
Date
PHOTO RELEASE FORM – Jack & Jill Playschool
****PARENTS AND GUARDIANS PLEASE READ CAREFULLY****
This form is to cover activities where individual students are identified and or interviewed with the
intent of the material being published and /or broadcast in local (usually local paper), provincial or
national newspapers, school website or television. This material will be used OUTSIDE the school
boundaries and under the Freedom of Information and Privacy Act, a separate consent form is
required.
Examples of these types of activities are:
- Names/pictures of classes/individual students participating in school
Fieldtrips published in the Leduc Representative and or other newspapers.
- Names/pictures of classes/individual students involved in a school activity
(Classroom holiday parties, special school presentations, etc.)
- Photo may include name, but will never include address or phone number.
- Social Media sites – Jack & Jill Playschool Facebook fan page
We realize that there may be occasions where you, as parents/guardians have concerns relating to
the publication of information. If you have issues with your child’s name and picture being published
or telecast, please indicate by circling your preference below.
I, _________________________ give Jack & Jill Playschool permission to take photos of my
child, ______________________ for use:
In the classroom:
yes / no
On our website/Facebook fan page:
yes / no
Local Media:
yes / no
Parent/Guardian Signature
Approved January 5, 2017
Print Name
Date
Withdrawal Agreement
I will give one month’s written notice via letter to the registrar at [email protected] when
withdrawing my child from the Preschool program. In order to withdraw my child from the program, I am
required to give my notice by the first calendar day of the month. For example, if I decide to withdraw
my child from the program for October 1st, then I must give one month’s notice to the Registrar
([email protected]) on or before September 1st.
Withdrawal notices will not be accepted for the months of May and June. April is the last month to
withdraw, which means your withdrawal notice would have to be in by March 1st.
I understand the registration fee of $100 is NON-REFUNDABLE. If I withdraw my child after
December 31, my *$150 fundraising will not be prorated and the *$50 toy cleaning commitment
will be forfeit. (* Unless commitments have been made through fundraising profit and toy cleaning
attendance)
Child’s Name: _____________________________________________
Enrolling Parent/Guardian Name (please print): ____________________________________
Enrolling Parent/Guardian Signature: _____________________________________________
Withdrawal Confirmation & Completion (for use in the event of withdraw):
Date of Written Notice
Received by Registrar:
Fundraising Commitment
Cheque # & Deposit Date:
Toy Cleaning Commitment
Cheque Number & Deposit
Date:
Parent Signature:
Registrar Signature:
Removal from Contact lists:
Approved January 5, 2017
Last Day of Student:
Monthly Tuition Cheque # &
Deposit Date:
Notes:
Criminal Record Checks and Alberta Intervention Checks for Volunteers
**** Please read this page carefully! There are 2 checks required ****
*** Each class will consist of two adults; our teacher and a parent/family representative (roster). In
order to provide the safest environment for our children we require two background checks on all
volunteers/roster parents. If you do not pass these checks or do not complete these checks you will
not be allowed to roster and your roster cheque may be cashed. Each check is only valid for one year.
Any member of your family can roster provided they have their background checks done. Please
consider getting a couple of people to do this (ex. mom, dad, grandparents, etc.). Siblings are not
permitted to attend class with the roster parent. **Note: Records checks do not apply to families who
pay the additional $50 fee each month to forgo rostering**
Do you plan roster for your child in the 2017-2018 school year?
Yes_______ (will require 2 records checks)
No_______ (will not require records checks; please ad $50/month to each monthly tuition cheque)
Criminal Record Check
In order to receive a free criminal record check a personalized request letter must be made for you.
Please provide our registrar with the name(s) of whoever will be rostering for your child. You will
need to pick this letter up from our registrar and drop it off at the police station in your community
(you cannot get it done in Leduc if you live in Edmonton, Wetaskiwin, Millet, etc). You can email the
registrar at [email protected]
The Leduc RCMP station is located at 1, 4119 50th Street, Leduc.
Alberta Child Intervention Record Check
The request for this check is submitted at the Alberta Children's Service's building located at 4901
50th Ave in Leduc. You do not need to provide a letter for this check and it is free of charge. You will
need two pieces of identification; one photo ID (driver’s license, passport) and an Alberta Health Care
Card/Blue Cross card. *No social insurance cards. They will send this request away and mail it to your
home in 2-3 weeks.
*** Please submit these checks starting July 1 to ensure they are completed and returned to the registrar PRIOR to
August 15 so roster schedules can be made before school starts.***
I understand that any record checks not received within 6 weeks of my childs start date will result in my roster
comittment cheque being cashed.
Parent Initial: ___________
Approved January 5, 2017
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Approved January 5, 2017