Leduc Society for Christian Education

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2021-2022 Preschool Registration

Part 1: Student Information

Last name, First name (ie Doe, John) *

Date of Birth (MM, DD, YYYY) *

Gender *

Male

Female

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: *

Yes

Immunizations Up-to-Date: *

Yes

Covenant Family(see handbook): *

Yes

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 : 2021-2022

Preferred Preschool Class: (may depend on enrollment numbers) Morning class is full. *

Morning

Afternoon

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, 2021)
Preschool Fee: $700.00/Child (Due September 1st, 2021)
*Please see options Below

Fee Payment Information: Check the appropriate Payment Option *

9 Post-Dated Cheques (Sept 1, 2021 to May 1, 2022 @ $77.78/month) Payable to Leduc Society for Christian Education(LSCE)

Monthly Automatic Bank Withdrawal - 10th of the month(submit void cheque or complete PAD form found here; ccs.blackgold.ca, under Preschool Registration)

Monthly Automatic Bank Withdrawal - 25th of the month(submit void cheque or complete PAD form found here; ccs.blackgold.ca, under Preschool Registration)

Monthly Credit Card Payment (pick up form at the office)

EFT to: payments.lsce@gmail.com Question: "what school is the payment for?" Answer: "Covenant"

Payment in Full - Due by September 30/21

Other (To be approved by LSCE Finance Committee)

Deposits or Credit Card Authorization Form

Due to the uncertainty of the pandemic, we will not be requiring parents to roster or clean at this time. This is subject to change, but those changes will be communicated throughout the school year.

Part 6: Parent Commitment

I/We will pay the amount in the method indicated above within the school year mentioned above. *

Yes

I/We give my child permission to use all the facilities at Covenant Christian School - gym, library, playground, etc. *

Yes

I/We give permission to publish our names, addresses and phone numbers in the school's annual directory. *

Yes

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. *

Yes

I/We have read the Preschool Parent Handbook(found here: ccs.blackgold.ca, under Preschool Registration) and agree with the policies outlined within. *

Yes

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. *

Yes

I/We have filled out the forms (medical, PAD & Credit Card forms) in the information package found here; ccs.blackgold.ca under Preschool Registration? *

Yes

Parent/Guardian Signature *

Submit

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