School's Cool 2022
Pre Screening Information Form
Deadline for application - June 15th, 2022
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Email *
Additional Information
Thank you for your interest in SIRCH's School's Cool Program. This summer the program will run for six weeks from July 11th to August 18th, Monday through Thursdays (4 days) from 9:00 a.m. to 1:30 p.m. You must commit to sending your child for all six weeks.
This is not first come, first serve. Children who need the program the most will be accepted first.
Todays Date *
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Name of Childs Parent/Legal Guardian (proof of guardianship will be required) *
Phone Number *
Mailing Address (Include P.O Box, Street Address, Town and Postal Code) *
Are you a resident of CKL/Haliburton/Muskoka County? *
Name of child *
Age of child as of September 2022 *
Are you registered/registering for a TLDSB School for Fall 2022? *
Date of Birth *
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How did you hear about the School's Cool Program? *
What concerns do you have about your child's learning? *
Is this a referral? IF YES, please provide the name of the organization, phone number, and reason for referral. IF NO, please put N/A *
You will need to have transportation to and from the school. Do you have a means of transportation to and from the school, each school day for 6 weeks? *
Has your child received, or are they receiving services from any other agencies? e.g. Speech Therapy, Occupational Therapy, Group Programming, etc. IF YES, please describe below. IF NO, put N/A *
Is your child toilet trained? *
Will your child be able to attend school 4 days per week for the entire 6 weeks? *
Location Preference *
Thank you. Our School’s Cool Coordinator will be in touch with you within the next 2 – 3 weeks to complete the screening process.
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