School's Cool In Person Screening Form

Thank you for your interest the School’s Cool program! We are very excited to meet you! School’s Cool is a proven early learning program that increases developmental skills of young children who are entering kindergarten. School’s Cool focuses on skills such as listening, reading, counting, patterning, socializing and, more importantly, helps prepare them for school. 

Please Note:  In the last couple of years, SIRCH has been very fortunate to have had funding from the Trillium Lakelands District School Board to be able to deliver School’s Cool in City of Kawartha Lakes and Muskoka as well as Haliburton County. SIRCH is only able to fund School’s Cool in Haliburton County in 2024.  School’s Cool will take place in-person at LOCATION HERE from July 8th to August 15th, 2024.

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Schools Cool Summer Session: *
Is this a referral? *
If yes, please provide the organizations name below *
Child's Name: *
Date of Birth: *
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Gender:  *
Contact Number: *
Email Address:  *
Primary Address: ( House number, Street , Town, postal code, P.O Box)
 *
Primary Parent/ Custodial Parent Name: 
 *
Primary Parent/  Custodial Parent Relationship to Child: 
 *
Has your child attended JK or Sk before? *
If yes, please specify if in person or  virtually.  *
Has your child participated in School's Cool previously? *
If yes, please specify what year and if your child attended in person or virtually. 
Will your child be attending school in September?  *
If yes, please specify below: *
Has your child attended any enrichment programs (early years, speech etc)? *
Does your child have transportation to and from the location? *
Is your child able to attend regularly throughout the 6 weeks? *
There is a fee of $240 ($10 per day). Will you require subsidy (help paying this fee)? *
Does your child require medication that will need to be administered by an instructor during the program hours? *
If yes, please specify below what medication, and how it is administered
Has your child been diagnosed with or you suspect any exceptionalities?   *
If yes, please check all that apply: *
Required
Name two areas you hope can be improved by your child's attendance at School's Cool. (For example social skills, language, math , attention, self-help skills, behaviour, anxiety). *
Please provide us with some information which will improve your child's experience in the program. (For example: likes/dislikes, interests, tips or tricks that help your child when they are upset etc)  *
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