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Registration Information – Part I
Child’s Name: / Age at time of Enrollment:
Date of Birth:
Address:
Postal Code: / Phone #:
Parent/Guardian (1) / Parent/Guardian (2)
Name: / Name:
Address (if different from above) / Address (if different from above)
Home Phone #: / Home Phone #:
Cell Phone #: / Cell Phone #:
E-mail Address: / E-mail Address:
Place of Employment: / Place of Employment:
Address: / Address:
Work Phone #: / Work Phone #:
Occupation: / Occupation:
Emergency Information
Contact Name: / Home Phone #:
Address: / Work Phone #:
Physician: / Phone #:
Address:
Does your child have:
Special diet or medical conditions?
Food or medication allergies?
Any medical treatment or medication which may need to be administered while you child is at school? Provide details below:
I hereby give permission for a physician to give necessary treatment in the case of an emergency situation where parents cannot be reached and a delay, in the opinion of medical staff, would be detrimental to the health of my child. It is understood that every effort will be made to contact the parents. This consent also gives the Supervisor permission to administer the above listed medications in the event of an emergency.
Signature of Parent/Guardian(1) / Signature of Parent/Guardian (2) / Date

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Registration Information – Part II
Are you a new or returning student to the Preschool New  Returning 
(NOTE - if returning, please specify what year(s)
attended ______)
How did you hear about our Preschool?
 Alumni  Residential flyer/brochure  Community postings  Internet  Outdoor advertisement  Community event
 Referral (pls. provide name of referring party) ______ Other (pls. specify) ______
NOTE: Tax receipts will be issued in February via email.
Enrollment Requested
Toddler / Monday
JK Readiness I / WednesdayFriday
JK Readiness II / Tuesday & Thursday
I wish to be: / Duty / Non – Duty / *Non-Duty families are only exempt from monthly parent duty requirements at the school, and are still required to participate in mandatory special fundraising events, co-op job and cleaning duties.
Additional Comments:
For office use only - Monthly Fee: $ ______
Date of Admission: Date of Discharge:
Child Pickup Authorization
Name / Address / Phone # / Relationship
1.
2.

Farmers’ Dell Co-operative Preschool of Glanbrook Inc.

Membership Enrollment Form

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Membership Pledge
We have read the Parent Handbook and hereby agree to abide by the rules and regulations of the Executive Committee and the General Membership. We agree to pay a non-refundable registration fee to hold child’s spot in class and monthly tuition fees based on Enrollment payable the 1st day of the month, and to comply with health and insurance rules.
We understand that the required duties of all adult members of Farmers’ Dell Co-operative Preschool include:
  • Mandatory attendance at every general membership meeting, as scheduled (4-5 per year) ** A missed meeting fee will be applied for general membership meetings not attended.
  • Participate in school functions, and school maintenance and cleaning
  • Perform a co-operative job as assigned by Executive Committee
Duty members must:
  • Participate as a teacher’s assistant in the classroom as scheduled. Scheduled days per month will vary according to Enrollment. Non-Duty members are exempt from this requirement.
  • Provide a Criminal Reference Check, including a Vulnerable Sector Check, TB Test with written results, date of last Tetanus/Diphtheria vaccine and date of Measles, Mumps, Rubella vaccine prior to working with children. Non-Duty members are exempt from this requirement.
We understand that failure to comply with the membership pledge could result in the removal of my child from Farmers’ Dell Co-operative Preschool program
Signature of Parent/Guardian(1) / Date / Signature of Parent/Guardian(2) / Date
Image Release Consent
I understand that in the course of activities, members and staff of Farmers’ Dell Co-operative Preschool may capture my child’s image and/or voice on still photograph, motion picture film, audio tape, video tape or digital media. These photos are typically kept in photo albums, posted throughout the classroom and/or used in a digital portfolio (i.e. See Saw App), however they could be used as promotional material.
I hereby agree that this material may be used solely to promote the preschool, in whole or in part, within the community, on Farmers’ Dell Co-operative Preschool’s website, in newsletters, in the classroom, and in a digital portfolio.
I do not give permission to use this material to promote the preschool, in whole or in part.
I hereby agree that any photos (still or video) that I may take of other preschool children during class time, outdoors or at
special preschool events will not be used on the internet (i.e. Facebook, Instagram, or e-mail, etc.)
Print Child’s Name / Signature of Parent/Guardian / Print Parent/Guardian’s Name / Date

Farmers’ Dell Co-operative Preschool of Glanbrook Inc.

Membership Enrollment Form

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Special Preschool Fundraising Events
We understand that Farmers’ Dell Co-operative Preschool will hold special fundraisers (Breakfast with Santa, etc.) throughout the school term that will require mandatory participation by members. Any monies raised from special fundraising events will help support the school directly and will not be applied to any fee requirements (i.e. enrollment, registration, etc.) unless otherwise stated and/or approved by the Executive Committee.
We have read, understood and agree to the Special Preschool Fundraising Events and conditions as noted above.
Parent/Guardian (1) Signature / Date / Parent/Guardian (2) Signature / Date
Co-operative Jobs
Farmers’ Dell Co-operative Preschool is run by an elected Executive Committee. There is also a list of other vital jobs within the preschool that must be filled by the membership. Each member of the preschool is required to perform one co-operative job.
The Executive Committee reviews membership Enrollment forms and assigns jobs based on skills, interests and job requests. It is understood that I may not be assigned the job I’ve requested; however, I will not be assigned an Executive position, unless requested.
I have reviewed the job descriptions of the co-operative jobs and would be interested in filling one of the following positions:
1. / Special interests and skills:
2.
3
For office use only:
Co-operative job assigned: ______Date: ______
Trip Consent
I hereby give consent for my child to be taken on supervised trips, provided that I am informed of each trip in advance. I will not hold any person in attendance at the school responsible in case of accident, contraction of illness or loss of personal property while on the trip. If my child has suffered an accident or sudden illness while on a trip, I hereby give consent for my child to receive emergency medical treatment, if I cannot be reached and a delay, in the opinion of medical staff, would be detrimental to the health of my child. I understand that the school’s insurance coverage extends to registered children only.
Signature of Parent/Guardian / Print Name / Date