Before and After CareDrop off as early as 7:00AM and pickup as late as 6:00PMChoose a Program *ProgramBefore and After CarePlease confirm this is the program you are interested in enrolling in.Participant's InformationPlease provide consistent registration information to make it easier to cross-reference multiple documents. Ie. First and Last name(s) only.Child's InformationFirst Name *Last Name *Date of Birth *Identified Gender *MFCurrent School *The school the student is enrolled in for the 2022-23 school year.Current Grade *Grade entered in September 2022Participant Address *Resides in 1 primary locationResides in multiple locationsAddress 1 *Address 1Apartment, suite, etcCityState/ProvinceZIP / Postal Code *Address 2Address 2 if applicableApartment, suite, etcCityState/ProvinceZIP / Postal CodeParent/Guardian InformationPrimary ContactPrimary Contact *The first person we will contact.Relationship *Legal Access *Custodial ParentAccess to School DocumentsPick-Up/Drop-OffEmail Address *Phone Number *Secondary ContactSecondary Contact *The second person we will contact.Relationship *Legal Access *Custodial ParentAccess to School DocumentsPick-Up/Drop-OffEmail Address *Phone Number *Emergency ContactsPrimary Emergency Contact *Third point of contact if Primary and Secondary contacts cannot be reached.Relationship *Phone Number *Secondary Emergency ContactFourth point of contact if Primary and Secondary contacts cannot be reached.RelationshipPhone NumberChild Custody AgreementDo you have a Child Custody Agreement? *YesNoIf yes, please attach.Custody AgreementChoose FileNo file chosenDelete uploaded filePlease upload a copy of the Custody Agreement for our records.Medical/Health InformationMedical ConditionsMedical Conditions *NoneAsthmaFainting SpellsHistory of Head InjuriesChronic NosebleedFeet or Leg ProblemsMigraneSeizuresDiabetesHemophilia/Bleeding DisordersRashSleepwalkingDigestive UpsetsRecent Illness or OperationUrinary InfectionsEar/Nose/Throat InfectionsOther: Please DescribeE.g. medical diagnosis and other health concernsOther Medical ConditionsTreatmentGive details of usual treatment for each of the above conditions indicated:Medications - If Applicable; What prescribed medication(s) does your child/ward take?A) TypeB) TypeA) DoseB) DoseA) Time/FrequencyB) Time/FrequencyA) LocationBackpack, Office, Pouch on StudentB) LocationBackpack, Office, Pouch on StudentA) Other needs/details (ie. take with food)B) Other needs/details (ie. take with food)Allergies/AsthmaAllergiesNo AllergiesMy child/ward has been prescribed an Epi-Pen by their doctorMy child/ward has suffered a serious allergic reactionMedication(s)Food(s) - please specifyOther (e.g. bee or wasp stings, environmental allergies)Other AllergiesIs the allergy considered:MildModerateSeriousLife-ThreateningNot ApplicableAnaphylaxis Emergency Plan - Please fill out and attach if applicableAnaphylaxis Emergency Plan Fillable FormCompleted Anaphylaxis Emergency PlanChoose FileNo file chosenDelete uploaded fileDietary RestrictionsPlease list any foods your child/ward should not eat for medical, dietary, or religious reasons.AsthmaNot ApplicableMy child/ward has AsthmaMy child/ward has been prescribed an inhaler for asthmaMy child/ward has suffered a serious asthma attacksMy child/ward has been prescribed an inhaler for another reason. Please ExplainAsthma DetailsHealth Card Number *Please include number and version codeImmunizations Up To Date?YesNo (explain)Immunization RecordChoose FileNo file chosenDelete uploaded filePlease upload participants immunization record.Not up to datePlease state why records are not up to dateDoctor's NameDoctor's Phone NumberDetailed Plan of CareKnown triggers & symptoms, emergency protocol/steps.Medical Treatment Authorization *I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.Registration Terms and AgreementsRegistration Terms Agreement *I have read, understand and agree to the terms of registration and enrolment in programs at Oak Learners and I have read and understand the policies and procedures laid out in the Parent Handbook.Payment and Policy InformationPlease read and check all sections to verify that you agree to our terms of registration.Responsibility for Fee Payment *I understand the feel schedule and penalty for missing a deadline. Parents are responsible for payment of fees per this schedule. Any student whose account has not been paid promptly or has not made acceptable payment arrangements with the office may not be permitted to attend class, school activities, re-enroll in the school.Deposit *I understand there is a non-refundable deposit to register for Day School. A deposit of $2500 is due upon registration to secure your child's placement. This deposit is only refundable if you choose to withdraw your child's registration prior to August 31, 2021. The full amount of the deposit will be applied towards the total tuition fees due.Withdrawal *I understand that notice of student withdrawal must be made in writing. Withdrawal after August 31, 2022 will result in 50% reimbursement of Tuition Fees for the remainder of the school year, less the deposit. Any fees still outstanding will be due upon withdrawal.Camps *I understand Camps are not included in the Before and After Care program. March Break Camp and Summer Camp fees are NOT included in the program fees. Camp details can be found on the website. Enrollment is subject to availability. We do offer PA day camp as part of the Before and After Care program, students must sign up the week of to hold a space for those days.What is the likelihood that they will attend for PA Days?LikelyUnlikelyUnsurePA Day camps are included in the fees, however we need to confirm attendance the week of the PA Day.Force Majeure Clause *I understand the Withdrawal Policy does not apply during a time of Force Majeure. The above withdrawal policy is not applicable during a time of Force Majeure; an Act of God or circumstances beyond our control (i.e. pandemic, quarantine, natural disaster, etc.). In such a Force Majeure situation, Oak learners will make every effort to provide instruction through Virtual Learning. In the case that Oak Learners is unable to provide comparable instructional programming through online learning methods, a credit towards tuition fees will be applied. All withdrawal requests made during the Force Majeure period will be provided with a credit, calculated as per the withdrawal policy towards future program registration. The lifetime credit can be used towards any future Oak Learners program registration and is transferable to any immediate family member.Consent DetailsPhotography Consent *I give full permission for the staff at Oak Learners to take photographs of myself or my child while under the care at our programs.I also give permission for Oak Learners to use these pictures for promotional purposes outside the program premises.I do NOT consent to any photographs being taken of my child/ward.For part of learning at our center, photographs will be taken to document our discoveries and experiences of the children. To protect the rights and privacy of the children in our programs, we need permission from the parent or legal guardian to take pictures of their child while attending programming by Oak Learners.Local Outings Consent *Students go on daily walking excursions and adventures in the local neighbourhood within a 5km radius of Oak Learners. I give permission for my child to go on neighbourhood outings and field trips within this distance. I release Oak Learners and individuals from liability in case of accident during activities related to regular programming, provided outlined safety procedures have been taken.Local Outings Vehicle Consent *By checking this box, I hereby grant permission for my child (named above) to be transported in the Oak Learners’ Vehicle during the 2022-2023 School Year. I agree to waive and release all claims, present or future, for damage, injury or loss to the student or the student’s or parent’s property which may be caused by any act, or failure to act, by the Oak Learners Inc, its administrative staff, teachers, employees, students, parents, or others acting on the school’s behalf and agree not to sue for relief arising from such claims. I release Oak Learners and individuals from liability in case of accident during activities related to transportation, provided normal safety procedures have been taken.Learner's ProfileIs there any other information you would like your child’s teachers to be aware of? *Please type your name as your e-signature to certify that all information on this form is complete and accurate. *Start signing your signature hereYour browser does not support e-Signature field.By typing your name in the box above, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your signature. Submit Registration Form
