Licensed Childcare Registration Package

"*" indicates required fields

Office Use Only

Date of Registration: _____________ In ActiveNet Y/N:____Staff Initial: ___________ Complete Y/N:____Staff Initial: ___________

ELECTRONIC SIGNATURE ACKNOWLEDGEMENT AND CONSENT FORM

I agree and understand that by signing the Electronic Signature Acknowledgment and Consent below, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
Type full name for signature that will be used throughout this package.
Please sign below

Participant Information

Upload a close up photo of your child or email one to osc@jamesbaycentre.ca
Accepted file types: jpg, png, jpeg, docx, Max. file size: 8 MB.
Child's Name*
YYYY/MM/DD
Example: Female, She/Her
YYYY/MM/DD
YYYY/MM/DD
Primary Address*

Parent/Guardian Information

Name (Contact 1)*
Mother, father, guardian, etc
Address (if different from child)
Example: Monday to Friday, 8am - 4pm
Name (Contact 2)
Mother, father, guardian, etc
Example - Monday to Friday from 9am to 5pm
Address (if different from child)

Emergency Health Information

Office staff may contact you for further information to develop a health care plan in order to best support your child.
Immunization Records*
Upload immunization records or email to osc@jamesbaycentre.ca
Drop files here or
Accepted file types: pdf, jpg, png, jpeg, docx, Max. file size: 8 MB.
    Reactions and treatment
    Examples: Vegetarian, Vegan, etc.
    Examples: asthma, seizures, hearing, vision, developmental delay

    Medical Permission

    If a situation should arise where it is deemed necessary to obtain immediate medical attention and staff are not able to reach parents/guardians, staff will transport your child to the nearest emergency treatment centre or contact an ambulance on your child’s behalf. Emergency services will be provided with a copy of your child’s health information. I authorize the staff of the James Bay Community School Centre Society, in the event of an accident or illness requiring emergency treatment affecting my child, to authorize on my behalf all procedures, including admission to hospital and any necessary treatment therein as he/she may deem essential for the care and well-being of the child. Such action is only to be taken when immediate contact with the undersigned cannot be made. It is understood that the JBCSC is not responsible for medical care or ambulance costs
    Medical Permission*
    I give my permission
    YYYY/MM/DD

    Emergency Contacts and Alternate Person(s) Authorized to Pick Up Child

    PARTICIPANTS WILL ONLY BE RELEASED TO PEOPLE ON THIS LIST. CONTACT THE COORDINATIOR TO MAKE CHANGES. ALL CONTACTS MUST BE ADULTS 19 YEARS OR OLDER.
    Name*
    Type of Contact*
    Check all that apply
    Name
    Type of Contact
    Check all that apply
    Name
    Type of Contact
    Check all that apply
    Name
    Type of Contact
    Check all that apply

    Persons Not Permitted Access to Child (Release of child or in-program visit)

    Name
    Name

    Custody or Other Legal Orders

    Do you have a custody agreement?
    If yes, please provide details below and upload a copy of the order to this package or bring to the Centre for photocopying.
    Accepted file types: pdf, jpg, png, jpeg, docx, Max. file size: 8 MB.

    Family and General Household Information

    Other than those already listed above
    Examples: Recent changes in living situation, significant events

    Behavioural Concerns

    Office staff may contact you for further information to develop a behaviour care plan in order to best support your child.
    Include information about challenges they have encountered in group settings or childcare environments. What strategies do you use at home?

    Previous Childcare Experience

    Has your child attended daycare, preschool, out of school care, or camps in the past?*
    Please describe challenges and successes, as well as tools that are helpful for your child.

    Additional Information

    Please share anything that would assist the staff in working with your child.

    Permission for Field Trip

    I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN FIELD TRIPS AND OUTINGS WITH CHILDCARE STAFF. I UNDERSTAND THAT ALL OUTINGS WILL BE PRE-PLANNED AND ADEQUATELY SUPERVISED. I UNDERSTAND THAT MY CHILD WILL BE TRANSPORTED TO FIELD TRIP LOCATIONS USING PUBLIC TRANSIT, JBCSCS VEHICLES, AND WALKING AS A GROUP. I UNDERSTAND THAT FIELD TRIP PLANS MAY CHANGE, AND AGREE TO MAKE ARRANGEMENTS IN ADVANCE WITH STAFF IF I NEED TO PICK UP MY CHILD EARLY.
    Permission for Field Trips*
    Please type your name as a digital signature confirming response to Permission for Field Trips

    Photo Release Permission

    IN ACCORDANCE WITH THE BC FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT (FOIPPA), THE JAMES BAY COMMUNITY SCHOOL SOCIETY IS SEEKING YOUR CONSENT TO COLLECT, KEEP, USE AND SHARE PHOTOGRAPHS AND/OR VIDEOS OF YOUR CHILD IN A VARIETY OF PUBLICATIONS, CENTRE DISPLAYS, AND THE JBCSC WEBSITE. I UNDERSTAND THAT IMAGES POSTED ON THE INTERNET MAY BE STORED AND ACCESSED OUTSIDE OF CANADA. EX: IMAGES MAY BE USED OR SHARED IN NEWSLETTERS, BROCHURES, AND REPORTS IN LIMITED CIRCULATION IN ADDITION TO WEBSITES AND SOCIAL MEDIA PLATFORMS WITH LIMITED OR PUBLIC ACCESS. THE JBCSC IS COMMITTED TO RESPECTING YOUR PRIVACY AND WILL ABIDE BY ANY RESTRICTIONS INDICATED ABOVE IN USING YOUR PHOTOGRAPH AND VIDEO FOOTAGE AND ACCOMPANYING PERSONAL INFORMATION. YOUR PERSONAL CONTACT INFORMATION WILL NOT BE SHARED WITHOUT YOUR CONSENT.
    Photo Release (Centre Use)*
    I AUTHORIZE THE JBCSCS AND APPROVED THIRD PARTIES TO USE PHOTOS/VIDEOS OF MY CHILD FOR IN-CENTRE USE, INCLUDING BUT NOT LIMITED TO NEWSLETTERS, BULLETIN BOARD DISPLAYS, PHOTO ALBUMS, COMMEMORATIVE ITEMS, AND REPORTS.
    Photo Release (External Use)*
    I AUTHORIZE THE JBCSC AND APPROVED THIRD PARTIES TO USE PHOTOGRAPHS/VIDEOS OF MY CHILD FOR EXTERNAL USE, INCLUDING BUT NOT LIMITED TO THE JBCSC WEBSITE, SOCIAL MEDIA PLATFORMS, AND ELECTRONIC COMMUNICATIONS.
    Please type your name as a digital signature confirming response to Photo Release

    Fee Agreement - Monthly Fees for 2024/2025: Before School Care: $100, After School Care: $275, Before & After School Care: $310, Pro-D Day: $25

    I UNDERSTAND THAT FEES ARE SUBJECT TO CHANGE WITH OR WITHOUT NOTICE SUBJECT TO THE APPROVAL OF THE JBCSCS. I AGREE TO PAY MY FEES IN FULL EACH MONTH, AND UNDERSTAND THAT FAILURE TO PAY FEES MAY RESULT IN THE SUSPENSION OF SERVICE. I UNDERSTAND THAT THE JBCSCS ACCEPTS CREDIT CARD, DEBIT CARD, CASH, OR CHEQUE AS PAYMENT METHODS, AND IS NOT SET UP TO STORE CREDIT CARD INFORMATION OR ACCEPT PRE-AUTHORIZED OR AUTOMATIC PAYMENTS. I AGREE TO PAY MY FEES ON OR BEFORE THE FIRST OF EACH MONTH. I UNDERSTAND THAT I AM REQUIRED TO GIVE 30 DAYS WRITTEN NOTICE FROM THE FIRST OF THE MONTH TO THE CHILDCARE COORDINATOR IN ORDER TO WITHDRAW OR CHANGE MY CHILD’S ENROLLMENT. FAILURE TO GIVE 30 DAYS NOTICE WILL RESULT IN FEES BEING CHARGED IN LIEU OF NOTICE. I UNDERSTAND THAT CHILD CARE SUBSIDY REQUIRES APPLICATION IN ADVANCE, AND IS SUBJECT TO APPROVAL OF THE MINISTRY OF CHILDREN AND FAMILY DEVELOPMENT. I UNDERSTAND THAT I AM REQUIRED TO PAY THE ENTIRE AMOUNT UNTIL THE APPROVED CHILCARE BENEFIT PLAN IS RECEIVED.
    Please type your name as a digital signature confirming that you agree to the Fee Agreement.

    Privacy

    THE PERSONAL INFORMATION YOU HAVE PROVIDED WILL BE REVIEWED BY JBCSCS STAFF AND APPROVED THIRD PARTIES, AND WILL NOT BE SHARED WITHOUT YOUR CONSENT. THIS INFORMATION MAY BE REVIEWED BY ISLAND HEALTH AUTHORITY LICENSING STAFF AS PER LEGISLATION. YOUR INFORMATION IS MANAGED IN ACCORDANCE WITH THE BRITISH COLUMBIA FREEDOM OF INFORMATION AND PRIVACY ACT (FOIPPA). YOU HAVE A RIGHT OF ACCESS TO COLLECTED INFORMATION. IF YOU HAVE QUESTIONS REGARDING FOIPPA, PLEASE CONTACT COMMUNITY SCHOOL COORDINATOR, AT 250-389-1470. *No Signature Required* James Bay Community School Centre Privacy Policy
    Consent to privacy policy*

    Parent/Guardian Informed Consent

    IN PERMITTING MY CHILD TO ATTEND CHILDCARE AT JAMES BAY COMMUNITY SCHOOL SOCIETY, I RELEASE AND DISCHARGE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES AND CAUSES OF SUIT OR ACTION THAT I OR MY CHILD HAVE AT ANY TIME AGAINST THE JAMES BAY COMMUNITY SCHOOL SOCIETY; ALONG WITH THEIR EMPLOYEES OR AGENTS; FOR ANY AND ALL INJURIES OR LOSSES SUFFERED BY MY CHILD AS A RESULT OF PARTICIPATING IN THE JAMES BAY COMMUNITY SCHOOL CENTRE CHILDCARE PROGRAMS.
    Please type your name as a digital signature consenting to the Parent/Guardian Informed Consent.

    Signature of Registering Parent/Guardian

    I HAVE COMPLETED THIS PACKAGE THOROUGHLY AND ACCURATELY TO THE BEST OF MY KNOWLEDGE AND ABILITY. I UNDERSTAND THAT PROVIDING INCOMPLETE OR INACCURATE INFORMATION MAY RESULT IN LOSS OF SERVICE.
    Please type your name as a digital signature confirming your registration