Out-of-School Care Program Application Form - Maple Ridge Christian School

Step 1 of 5

Phone

This field is for validation purposes and should be left unchanged.

Please complete one application per child.

Important Documents

You will need important documents on hand to complete this form such as:

Copy of Birth Certificate
Copy of Citizenship (If not born in Canada)
Copy of Immunization Record (if applicable)
Copy of inclusive educational reports, assessments (if applicable)

First and Last Name of Person Completing this Form(Required)

First Last

The information collected on this form is used and disclosed by Maple Ridge Christian School in accordance with the Personal Information Privacy Policy for Parents and Students of MRCS, a copy of which is available from the school office.

I acknowledge that submission of this application does not guarantee a spot in the program for my child.

Child's Information

Child's Name(Required)

First Last

Date of Birth(Required)

Grade (at requested start date)(Required)

Please upload a copy of your child's birth certificate(Required)

Max. file size: 2 MB.

Address(Required)

Street Address Address Line 2 City Province Postal Code

Parent/Guardian Information

Parent/Guardian 1 Name(Required)

First Last

Relationship to Child(Required)

Home Phone

Cell Phone(Required)

Email(Required)

Work Address

Street Address Address Line 2 City Province Postal Code

Work Phone

Parent/Guardian 1 Citizenship(Required)

Canadian Citizen

Permanent Resident

Work Permit/Travel Visa/Other

Please Upload a Copy of your Permanent Residency Card

Max. file size: 2 MB.

Please Upload a Copy of your Work Permit/Travel Visa/Other Citizenship Document

Max. file size: 2 MB.

Parent/Guardian 2 Name

First Last

Relationship to Child(Required)

Home Phone

Cell Phone(Required)

Work Address

Street Address Address Line 2 City Province Postal Code

Work Phone

Parent/Guardian 2 Citizenship

Canadian Citizen

Permanent Resident

Work Permit/Travel Visa/Other

Please Upload a Copy of your Permanent Residency Card

Max. file size: 2 MB.

Please Upload a Copy of your Work Permit/Travel Visa/Other Citizenship Document

Max. file size: 2 MB.

Emergency and Medical Information

Emergency Contact (Other than Parent/Guardian)(Required)

First Last

Relationship to Child(Required)

Home Phone

Cell Phone

Child's Care Card Number(Required)

Doctor's Name(Required)

First Last

Doctor's Phone(Required)

Dentist's Name(Required)

First Last

Dentist's Phone(Required)

My child has received the recommended immunizations(Required)

Yes

Other

Please check if applicable(Required)

My child has allergies.

My child requires medication.

My child has dietary restrictions.

My child has other health concerns.

My child does not have health or medical concerns.

Please specify