Out-of-School Care Program Application
Step
1
of
5
20%
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.
(Required)
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)
MM slash DD slash YYYY
Grade (at requested start date)
(Required)
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Please upload a copy of your child's birth certificate
(Required)
Max. file size: 2 MB.
Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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)
Email
Work Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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
No
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
Additional Information regarding your child
Special interests, fears, needs, or routines you would like us to know.
Does your child require any inclusive educational supports (speech, autism, etc):
(Required)
No
Yes
If yes, please explain
Please upload any files related to your child's inclusive education needs
Drop files here or
Select files
Max. file size: 2 MB, Max. files: 3.
Authorized Pick-Up Person 1 (Other than Parents/Guardians)
(Required)
First
Last
Relationship to Child
(Required)
Phone
(Required)
Authorized Pick-Up Person 2 (Other than Parents/Guardians)
First
Last
Relationship to Child
Phone
Out-of-School Care Schedule
Requested start date (month/year)
(Required)
Please indicate how many days of the week your child will require care
(Required)
1 day
2 days
3 days
4 days
5 days
Preferred Days
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Occasional/Drop-in (if space is available)
Shift Work or Rotating Schedule
Check all that apply.
Time care is needed
(Required)
Before school
After school
Before and after school
Other
Preferred drop-off time
(Required)
Preferred pick up time
(Required)
Permissions
Permissions
I give permission for my child to participate in local walking field trips.
I give permission for photos of my child to be used for program purposes.
I give permission for staff to obtain emergency medical care for my child if necessary.
By typing my name below, I hereby certify that the information provided is true and complete to the best of my knowledge. I understand that it is my responsibility to update the school with any changes.
MRCS accepts a typed signature for online forms
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
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