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REQUIREMENTS PRIOR TO ADMITTANCE

 

1.  A completed health assessment.

2.  Copy of your child’s updated immunization record.

3.  Completion of all Enrollment and Emergency forms.

-        Page 1-6, including the Child Allergy Survey.

-        Last page of Parent Handbook (Registration Agreement).

4.  Busing Contract (A.O.K. Band Members only (if applicable).

5.  Non-Band Member Agreement Form (if required).

6.  Completion of the Referral for Special Needs Resources.

 

 

ITEMS REQUIRED FOR EACH DAY AT DAYCARE

 

1.  Indoor shoes.

2.  Child size blanket.

3.  Change of clothing.

4.  Diapers or pull-ups & wipes.

5.  Outdoor clothing (hat, sweater or jacket)

* Please label all of your child’s belongings with permanent pen or marker.

 

 

 

 

 

 

 

 

 

Negaan’abik Day Care Centre

Enrollment & Emergency Form

Child’s Last Name

Middle Name

First Name

Date Of Birth

 

 

 

 

Child’s Telephone #

First Nation Name

Band #

 

 

 

Mother’s Name:

Father’s Name:

Telephone #

 

Telephone #

 

Cell #

 

Cell #

 

Child’s Complete Home Address:

Child’s Complete Mailing Address:

 

 

 

 

 

 

Mother’s Complete Home Address:

(if different from child’s address)

Father’s Complete Address:

(if different from child’s address)

 

 

 

 

 

 

Mother’s Place of Employment:

(Please include name and address)

Father’s Place of Employment:

(Please include name and address)

 

 

 

 

 

 

Work # :

Work #:

Guardians Complete Home and Mailing Address:

Specify the days you will require child care.

 

Monday

 

Tuesday

 

Wednesday

Telephone:

Thursday

Place of Employment:

Friday

Address:

 

Work:

 

 

 

Page 1

EMERGENCY CONTACTS

(Person’s to be called if parents cannot be reached)

1.    Name:

2.    Name:

Relationship to the Child:

Relationship to the Child:

 

 

Address:

Address:

 

 

 

 

Telephone:

Telephone:

Cell:

Cell:

Work:

Work:

3.    Name:

 

Relationship to the Child:

 

 

 

Address:

 

 

 

 

 

Telephone:

 

Cell:

 

Work:

 

Other Person’s or Siblings living in the Household

Name:

Age Under 18

Relationship to Child

 

Yes             No

 

 

Yes             No

 

 

Yes             No

 

 

Yes             No

 

 

Yes             No

 

Child’s Health Card Number: (optional ):

Name of Child’s Physician:

Name of Child’s Dentist:

 

 

Complete Mailing Address:

Complete Mailing Address:

 

 

 

 

 

 

 

 

Physician’s Telephone #

Dentist’s Telephone #

Page 2

 

Has your child had any previous communicable diseases?      Yes         No

If “Yes” please give Date/ Month/ Year:

Please Explain:

 

 

 

Has your Child had any previous illnesses or injuries?            Yes         No

If “Yes” please give Date/ Month/ Year:

Please Explain:

 

 

 

Please note any special medical conditions or known allergies:

 

 

 

Please provide assessment information if your child has special needs:

 

 

 

Is your child immunized?       Yes         No

Please provide a copy of your child’s immunization record.

If “No” please explain the reason for not being immunized. (Medical Religion Conscience)

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3

Does your child require medication on a regular basis?         Yes          No

If “Yes”, what s the name of the medication.

 

Please state administration details for this medication.

 

 

Is your child on a special diet?        Yes            No

If “Yes” please explain Special Diet.

 

 

 

Date Of Admission:       Month:                          Day:                        Year:

Date Of Discharge:        Month:                          Day:                        Year:

Day Care Supervisor’s Notes:

 

 

 

 

Parent or Guardian Signature:

Date:

Day Care Supervisor Signature:

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 4

Permission Slip (Consent of Parent or Guardian)

 

1.     I hereby grant permission for ________________________________ to use all play equipment and participate in all activities of the Negaan’abik Day Care.

 

2.     I hereby grant permission for _______________________________ to be included in pictures (media) connected with the Negaan’abik Day Care.

 

3.     I hereby grant permission for ______________________________ to be included in videotaping connected with Negaan’abik Day Care.

 

4.     I hereby grant permission for ____________________________ to go on field trips with the class. I understand that I will be notified prior to a scheduled class trip, and will be given information regarding transportation, destination, lunch or other food, arrival and departure times.

 

5.     I hereby grant permission for ________________________ to be checked by the local Health Nurse and Community Health Representative on a monthly basis.

 

6.     I hereby grant permission for any staff member of the Negaan’abik Day Care to contact my child’s emergency contacts listed, if my child needs to be picked-up and I cannot be reached.

 

7.     I hereby grant permission for _______________________ to be included in evaluations. YES   NO

 

I HEREBY GRANT PERMISSION FOR ANY STAFF MEMBER TO TAKE WHATEVER STEPS NECESSARY TO OBTAIN MEDICAL AID IF NEEDED.

 

 

________________________________                      _____________________________

Parent or Guardian Signature                                     Date

 

 

________________________________                      ______________________________

Day Care Supervisor’s Signature                                Date

 

 

 

 

 

 

 

Page 5

AGREEMENT BEWEEN

NEGAAN’ABIK DAY CARE CENTRE

AND

 

_______________________________________

(APPLICANT)

 

 

I, _____________________________ understand that my child may be registered into the Negaan’abik Day Care Centre only under the following conditions:

 

1.     Provided that there is an available space for your child.

 

2.     Provided that he or she will utilize the space until it is required by a member of the Aundeck Omni Kaning First Nation. At such a time, I understand that I will be given (2) week notice informing me that the available space that my child is utilizing is needed by an A.O.K. band member.

 

3.     Provided that I deliver and pick up my child daily as indicated on the application form (hours of care required). Also, I will inform the day care staff of any schedule changes or absences from the Negaan’abik Day Care Centre.

 

4.     Provided that I adhere to all policies and procedures stated in the Parent Handbook. As well as adhering to all other policies and procedures created by the Ministry, and Aundeck Omni Kaning’s Chief and Council.

 

 

__________________________________                   _________________________________

Signature of Parent or Guardian                                    Date

 

 

__________________________________                   _________________________________

Day Care Supervisor’s Signature                        Date

 

 

 

 

 

 

 

 

 

 

Page 6

CHILD ALLERGY SURVEY

 

To Parent(s)/Guardian(s):

 

This survey is designed to obtain information concerning life-threatening allergies. Please return the completed survey to the Negaan’abik Day Care Centre.

 

_______________________________                      ___________________________________

Student’s Name                                                          Parent’s Name

 

 

1.      Does your child have a life threatening allergy?                     Yes                  No

 

2.      Does your child have any allergies which produce any of the following symptoms following exposure to a particular material?

a)      Difficulty breathing or swallowing?               Yes                  No

b)      Fainting or collapse?                                       Yes                  No

c)      Swelling of the tongue, lips or face?              Yes                  No

d)     Other (specify)                                                Yes                  No

 

3.      Have any of the symptoms referred to in question 2 occurred after:

a)      Eating a particular food?                          Yes                  No

b)      Receiving an insect bite?                          Yes                  No

c)      Receiving a sting?                                     Yes                  No

 

IF YOU RESPOND TO ANY OF THE FOLLOWING QUESTIONS PLEASE CONTINUE.

 

4.      Has your child been seen by a medical doctor for the treatment of an allergic reaction?                 

Yes                  No

 

5.      Has your child been tested for allergies?        Yes                  No

 

6.      Have you been told by your medical doctor that your child requires an emergency medical kit available at the Centre?                        Yes                  No

 

7.      What foods or materials must your child avoid? _________________________________________

 

_______________________________________________________________________________

 

8.      Name of family doctor:  _________________________________.

 

I agree that this information will be shared, as necessary, with the staff of the Negaan’abik Day Care Centre and health care systems.

 

 

_____________________________________                      _______________________________________

Date                                                                                        Parent’s Signature

 

 

 

 

Page 7

LOGO.jpg_____________________________________________________Aundeck Omni Kaning

Negaan’abik Day Care

R.R. #1, Box 130

Little Current, Ontario

P0P 1K0

Office: (70) 368-2196

Fax: (705) 368-1720

 

 

Transportation Contract

 

I/We, ____________________________ will be fully responsible in assisting my/our child,

 

____________________ to get ON/OFF the bus daily. I/We will be responsible for meeting

 

my/ our child at the end of the day when he/she arrives home. I/We am/are aware that busing

 

service is a privilege and not mandatory.  Should I/We abuse this privilege, I/We will be

 

required to transport my/our child to and from Negaan’abik Day Care Centre.

 

     I /We am/are aware that Negaan’abik Day Care Staff are not responsible for any mishaps.

 

Incidents that occur while my/our child is/are transported to and from Day Care.

 

Children picked up at the Little Current Public School to home, will not be the responsibility

 

of  Negaan’abik Day Care.

 

 

__________________________________              ______________________________

Parents/ Guardian Signature                     Date                            Supervisor’s Signature                        Date

 

 

______________________________________

Parents/ Guardian Signature                     Date

 

 

 

 

 

 

C.C. Brian’s Bussing Service

 

 

“Taking Care of Our Future”

Page 8