Leduc Society for Christian Education
2020-2021 Preschool Registration
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Part 1: Student Information
Last name, First name (ie Doe, John) *
Date of Birth (MM, DD, YYYY) *
Gender *
Address *(Please provide Physical Location if address listed is R.R. or P.O.#): *
City: *
Postal Code: *
Allergies:
Other Health Concerns and/or Special Needs:
On-Going Medication:
Completed a Medical Authorization Form: *
Immunizations Up-to-Date: *
Covenant Family(see handbook): *
Part 2: Parent/Guardian Information
Parent/Guardian#1 - Last Name, First Name: *
Parent/Guardian #1 - Mailing Address: *
Please provide Physical Location if address listed above is R.R. or P.O.#: *
Parent/Guardian #1 - City: *
Parent/Guardian #1 - Postal Code: *
Parent/Guardian #1 - Home Phone: *
Parent/Guardian #1 - Cell Phone: *
Parent/Guardian #1 - Work Phone:
Parent/Guardian #1 - Email(email address that is checked regularly and is shareable): *
Parent/Guardian #1 - Relationship to Child: *
Parent/Guardian #2 - Last Name, First Name:
Parent/Guardian #2 - Mailing Address:
Please provide Physical Location if address listed above is R.R. or P.O.#:
Parent/Guardian #2 - City:
Parent/Guardian #2 - Postal Code:
Parent/Guardian #2 - Home Phone:
Parent/Guardian #2 - Cell Phone:
Parent/Guardian #2 - Work Phone:
Parent/Guardian #2 - Email:
Parent/Guardian #2 - Relationship to Child:
Part 3 : Emergency Contact Information (Note: Other than parents)
*Required for Licensing
Last Name, First Name: *
Mailing Address (Please provide Physical Location if address listed is R.R. or P.O#): *
City: *
Postal Code: *
Home Phone: *
Cell Phone: *
Relationship to Child: *
Part 4: Other Information
Registering for School Year : 2020-2021
Preferred Preschool Class: (may depend on enrollment numbers) *
Part 5: Payment Information
No Application is complete until the application fee is received.
If you have any questions or concerns, please contact Lisa Gatzke at lisa.gatzke.lsce@gmail.com
Fees
Application Fee: $50.00/Child (Due at time of application)
Supply Fee: $50.00/Child (Due September 1st, 2020)
Preschool Fee: $700.00/Child (Due September 1st, 2020)
*Please see options Below
Fee Payment Information: Check the appropriate Payment Option *
Deposits or Credit Card Authorization Form
We require Roster and Cleaning Deposits at time of Application
(Shredded at Year End if Tasks Completed)

Cleaning Deposit: $100.00/Child  Post-Dated to May 31, 2021
Roster Deposit: $400.00/Child - 4 Cheques @ $100.00 each  Post-Dated to:Sept 15/20, Dec 31/20, Mar 1/21, May 31/21.
There are two methods of Payment that you can choose from to cover your deposits: *
Required
Part 6: Parent Commitment
I/We will pay the amount in the method indicated above within the school year mentioned above. *
I/We give my child permission to use all the facilities at Covenant Christian School - gym, library, playground, etc. *
I/We give permission to publish our names, addresses and phone numbers in the school's annual directory. *
I/We give permission to use student's name, photo, video or comments in the preschool calendar, newsletters, other publications, for birthday recognition or on artwork or other material displayed at the school. *
I/We have read the Preschool Parent Handbook(found here: ccs.blackgold.ca, under Preschool Registration) and agree with the policies outlined within. *
I/We have read the "Accident & Illness" and "Administration of Medicine" policies of the Parent Handbook and give the responsible adult in charge of my child at CCS Preschool, permission to use the necessary measures in case of a medical emergency when immediate action must be taken. *
I/We have filled out the forms (medical, PAD & Credit Card forms) in the information package found here; ccs.blackgold.ca under Preschool Registration? *
Parent/Guardian Signature *
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