2015/2016 P.A. DAY REGISTRATION FORM ONE PER CHILD

2015/2016 P.A. DAY REGISTRATION FORM ONE PER CHILD

ACCOUNT NUMBER

Our full-day care runs from 7:30 am to 6:00 pm. Your child’s day will include organized activities, snacks, and an off-site activity or special visitor. Children are supervised by qualified educators. In September the off-site activities or special visitor information will be posted at your Program. FEES PER P.A. DAY: DATE OF P.A. DAY

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Kindergarten Children $43.00

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Gr. 1 and Older Children $40.00

Second and subsequent child(ren) 50% off lowest fee. If you are currently receiving financial assistance, contact your Program Coordinator if you have questions about your fees. PAYMENT OPTIONS:

(payment processed)

INITIAL TO CONFIRM CHOICES

DEADLINE FOR REGISTRATION OR WITHDRAWAL

October 2, 2015 (TVDSB only)

September 18, 2015

November 20, 2015

November 6, 2015

January 15, 2016

January 1, 2016

June 10, 2016

May 27, 2016

Pre-authorized Debit (PAD): If you are signed up for PAD your fees will be directly withdrawn from your account on each P.A. Day for which your child is registered. Cheques: If you are not signed up for PAD, a separate cheque must be submitted with this form for each P.A. Day for which your child is registered. Registrations cannot be processed until payment arrangements are received. CANCELLATION: Notice must be given to your Program Coordinator no later than two weeks prior to the P.A. Day. Fees will be charged if the required notice is not given. PLEASE NOTE: There is a minimum number of registrations required at each site. If the required number is not met your child will be moved to an alternate location. _______________________________________________ Child Name (Please Print)

___________________________________ Daytime Phone Number

_______________________________________________ School

I give permission for my child to attend the above initialed P.A. Day program(s), with transportation provided by Murphy Bus Lines. ________________________________________________ Parent’s/Guardian’s Signature

___________________________________ Date

I acknowledge that emailing this form serves as my signature.

Return registration form and cheque(s) (if applicable) to your Program Coordinator by e-mail, fax 519-471-5679, or submit to London Children’s Connection, 346 Wonderland Rd S. N6K 1L3