Millwoods Christian School Society

Preschool Registration – 2017/2018

Complete pages 1 and 2 only & email to

Area for general notes or additional information at the bottom of page 2

All fields will expand as needed

  1. Parental Information

Family Name: Preferred Email Address:

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Father’s Full Name: Home #: Cell #:

Address: City: Prov: Postal Code:

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Mother’s Full Name: Home #: Cell #:

Address: City: Prov: Postal Code:

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Emergency Contacts: 2 contacts (not parents) required for licensing, all fields mandatory

Contact #1 Full Name: Home #: Cell #:

Address: City: Prov: Postal Code:

Contact #2 Full Name: Home #: Cell #:

Address: City: Prov: Postal Code:

  1. Student Information

Student #1 Name: Birthdate(mm/dd/yy) Gender (M/F)

Student #2 Name: Birthdate (mm/dd/yy) Gender (M/F)

IMPORTANT: Names of people authorized to pick up your child(ren):

C. Medical Information: NOTE THAT THE STUDENT MUST BE COMPLETELY POTTY TRAINED – NO DIAPERS

  1. Alberta Health Care Number: Are your child’s immunizations up to date (Y/N)?
  2. Are there any allergies (Y/N)? If Yes, please specify:
  3. Name of Student’s Doctor: Doctor’s phone number:
  4. Is your child currently taking any prescription medication (Y/N)? If Yes, please specify medication and for what illness:
  5. Is teacher required to administer any medication (Y/N)? If Yes, Medication Consent form reqd.
  6. Any other medical, behavioral or learning issues you would like the preschool teacher to be aware of?

Should your child require emergency medical treatment, this is the procedure we will follow:

  1. First aid will be administered to the child
  2. Parent or emergency contact person will be notified by preschool office
  3. If further medical procedure is needed, an ambulance will be called and your child will be taken to the Grey Nuns Hospital Emergency department accompanied by the teacher. The parent or emergency contact person will be asked to meet the child at the hospital. The teacher will remain with the child until the parent or emergency contact person arrives.

D. Preschool & Society Fees

Name of Student #1: Student #2 (if applicable)

Indicate Y for Yes or N for N for each of 1 through 4:

1. Our Family is new to Millwoods Christian School and Preschool

2. My child is re-enrolling in MCS Preschool

3. My child has an older sibling who already attends MCS (Preschool and K-12

4. My child has an older sibling who will apply to attend MCS (Preschool,K-12) in the 2017/18 school year

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Preschool Class Selection and Corresponding Fees(Indicate Y for Yes or N for No for each of 1 through 4 ):

Y 1.$100.00 Non-Refundable Registration Fee(due at time of registration)

Y 2.$1200.00 2 Days Per Week, 10 month program for 3 and 4 year olds(Choose preferences):

Indicate 1 for FIRST CHOICE / Indicate 2 for SECOND CHOICE
Mon-Wed-AM 8:50 to 11:20 am / Mon-Wed-AM 8:50 to 11:20 am
Mon-Wed-PM 12:30 to 3:00 pm / Mon-Wed-PM 12:30 to 3:00 pm
Tues-Thurs-AM 8:50 to 11:20 am / Tues-Thurs-AM 8:50 to 11:20 am
Tues-Thurs-PM 12:30 to 3:00 pm / Tues-Thurs-PM 12:30 to 3:00 pm

3. $500 Optional 3rd Day for 4 Year Olds

  • Optional advanced preparation for 4 year olds attending kindergarten the following year.
  • Friday mornings 8:50 to 11:20 am, available to all students also enrolled in any one of the above preschool classes.
  • Students must be at least 4 years old by September 1, 2017

4. I would like to receive a 5% discount by paying preschool fees by August 31, 2017. IMPORTANT: To qualify,

please provide apost-dated cheque if lump sum. VOID cheque or EFT Authorization form required for monthly payments

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Payment Details

1. Payment Frequency(Indicate Y for preference): Lump Sum

Monthly Payments over 2-6 months (no fee)

Monthly Payments over 7-10 months (5% surcharge)

2. Payment Method(Indicate Y for preference): Cheque (lump sum)

Credit Card (for lump sum or monthly payments)

EFT Withdrawal from Bank Account (monthly payments)

IMPORTANT:Registration Fees are non-refundable. Payments must have started by July 2017.

Dishonored cheques/payments will incur a $20 service charge. Payments must be replaced within 30 days.

Withdrawal from school during the year requires an additional charge equal to one month of preschool fees.

“Alberta Preschool Subsidy” payments are applied against fees once payments are received from the government.

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GENERAL NOTES: Add any additional notes here, fields will expand: )

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*** THIS PAGE TO BE COMPLETED BY REGISTRAR ***

IN OFFICEOR AT PRESCHOOLOPEN HOUSE ON MAR 2/17, Drop in, 5 to 7 pm

E. Payment Authorization: Name of Student #1: Student #2 (if applicable)

Registration Fee:$100.00 ______ (due in full at time of registration)

Preschool Fees:2 Day Program(first child)$1200.00 ______

2 Day Program (second child)$1075.00 ______

Optional 3rd Day$500.00 ______

Adjustments:5% Discount: On Preschool Fees Paid by August 31, 2017- ______

5% Surcharge: On Monthly Payments over 7 to 10 Months+ ______

Final Total Due $ .00

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2. Method of Payment:

Payment FrequencyLump Sum Monthly 2 to 6 MonthsMonthly 7 to 10 months

Payment MethodChequeCredit CardBank Account

For Monthly Payments:

  • Withdrawal Date11520Last Day of Month
  • Documentation:VOID ChequeEFT Authorization Form (copies attached)

Credit Card #: ______Exp. Date: ______

  • Starting MM/YY ______Ending MM/YY ______Payment Amount______

* I hereby agree to the above financial costs and commit to pay the full amount in the specified time frame

* Failure to keep my account in good standing could result in student(s) not being re-enrolled in the school

* I agree that should there be an NSF cheque, credit card denial or EFT denial, the remaining monthly payments will be increased to include the delinquent amount plus a $20 service charge

Card/Account Holder Name:______Verified: __________

Parent Name: ______Parent Signature: ______

Date:______

F. Consent

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Preschool Photo Consent

- I consent to photographs, first names and birthdays of my child(ren) to be displayed or used in the classroom only. Including licensing requirements, in school promotional activities, scrapbook, etc.

- Any photos (no names or birthdates) of my child that may be seen in a public forum, such as on the open house bulletin board orpreschool website, will first require my specific permission.

In-House Field Trip Consent

Any activity outside the classroom is considered to be “off the licensed premises”. Our program will include in-house field trips this year, as well as occasional trips to the church, school, fields and playgrounds.

Signature: ______

Date: ______

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