Transitions Registration Form A. Child RegistrationChild 1Child 1:First NameLast NameMale/Female:Date Of Birth:Hours Of Care:Preferred Location:Child 2Child 2:First NameLast NameMale/Female:Date Of Birth:Hours Of Care:Preferred Location:Session DatesPlease Indicate SESSION DATES AND LOCATION REQUIRED:*Junior Program (Ages 5-7) *Senior Program (Ages 8-12)Child 1 DatesJuly 2nd - July 12thJuly 15th - July 26thJuly 29th - Aug. 9th Aug. 12th - Aug. 23rdChild 2 DatesJuly 2nd - July 12thJuly 15th - July 26thJuly 29th - Aug. 9th Aug. 12th - Aug. 23rdPreferred LocationOur Lady of Fatima SchoolLaroche ParkDebra Dynes Family HouseSt Rose of Lima E.S.Pallister Community HouseMadden CourtDraffin CourtCarson Comunity HouseConfederation Court Community HouseRussell Heights Community HouseLocation Descriptions Our Lady of Fatima School2135 Knightsbridge Road8:00am to 5:00 pmJr. Program July 2nd to August 23rdSr. Program July 2nd to August 23rd Laroche Park7 Stonehurst Ave.8:30am to 4:30 pmJr. Program July 2nd to August 23rdSr. Program July 2nd to August 23rd Debra Dynes Family House955 Debra Ave.9:00 am to 4:30 pmJr. Program July 2nd to August 23rdSr. Program July 2nd to August 23rd St Rose of Lima E.S.50 Bayshore Dr.8:00 am to 5:00 pmJr. Program July 2nd to August 23rdSr. Program July 2nd to August 23rd Pallister Community House48 A Dalkowski Prv.Jr. Program TBDSr. Program TBD Madden Court16 Kilbarron Rd.Jr. Program TBDSr. Program TBDSr. Program TBD Draffin Court101 Draffin Crt.Jr. Program TBDSr. Program TBD Carson Comunity House710-102 Carsons Rd.8:30 am to 4:30 pmSr. Program July 2nd to August 23rd Confederation Court Community House2483 Wakley Rd.8:30 am to 4:30 pmJr. Program July 2nd to August 23rd Russell Heights Community House1799E Russell Rd.*2019 Session Dates to be determined Notes*Before submitting your application please ensure your child meets the age requirement for your site location, and session dates. COST OF PROGRAM: $300 per 2 week session / SUBSIDIES AVAILABLEPayment StatusFull FeeCity of Ottawa Child- Care SubsidyOtherIf Other please indicate: If currently using a City Of Ottawa Subsidy, Please indicate the agency your are registered with:Child care subsidy must be approved prior to child attending campB. InformationPrimary Contact Name: *Primary Email: *MotherMother:Last Name:First name:Home Phone:Business Phone:Home Address:Postal Code:Bus. Address:Postal Code:FatherFather:Last Name:First name:Home Phone:Business Phone:Home Address:Postal Code:Bus. Address:Postal Code:C. Child Medical InformationChild 1Child 1:Name of Child:Allergies:Child 2Child 2:Name of Child:Allergies:Emergency Contact PersonEMERGENCY CONTACT PERSONName:Home Phone:Work Phone:Address:Relationship:I give permission for my child to receive emergency medical treatment due to sudden illness or accident, including anesthetics and medication by a private Physician or Hospital. *YesNoIndicate any special care requirements that your child may have e.g. Physical illness, learning disability, A.D.D:TermsRESPONSIBILITIES FOR PARENTS USING "TRANSITIONS" 1. HOURS OF CARE/ABSENTEEISM: *Parents must advise the Transition Counsellor if the child is going to be absent or late. 2. DELIVERY OF CHILDREN TO/FROM Program: Parents are responsible for dropping off their children at and picking them up from the Transition program. They must advise the Transition Counsellor in advance if someone other than the regular person will be dropping off or picking up the child. Where custody agreements permit access by both parents, drop off and pick up must be arranged with a minimum of disruption to the child or children. A copy of the court order or custody document will be required for situations where access by a parent is denied. The Transition Counsellor is not responsible for the children when they are walking between the home and the program location. 3. CHANGES IN RESIDENCE/WORK ETC. Emergencies and other situations do arise where parents must be reached. Parents must therefore notify the Transition Counsellor and the Agency of the following changes that may occur: a) Parents place of residence b) Home and business telephone numbers c) Emergency person's name & telephone number d) Child's doctor's name and telephone number 4. SUBSIDY: Where applicable, parents are responsible to ensure that subsidies are up to date. Any absence from the program is counted towards the total number of days allotted for absence in a year. 5. PAYMENT OF ACCOUNTS: Cheques are payable to "The Children's Village of Ottawa- Carleton. In the case of delinquent payments the Children’s Village of Ottawa-Carleton will send pertinent personal information to a 3rd party collection agency. 6. AGENCY INVOLVEMENT: Parents are advised to report any concerns or complaints regarding the Transitions program. We would also enjoy hearing your positive feedback. 7. ILLNESS: Parents are responsible for their child's care when the child is ill and requires special care (i.e. fevers, diarrhoea) or has an Infectious or communicable disease. 8. DRUGS AND MEDICATION: Parents must provide written authorization and information for the administration of all prescription and non-prescription drugs. Drugs and medications must be brought in their original container, (including over the counter medications and vitamins) 9. LUNCH/SNACK/: Parents must provide lunch and snack for their children. 10. OTHER: Parents must ensure that children come dressed appropriately for the weather and are provided with sunscreen. 11. PERMISSION FORMS: Parents must read and sign the permission form relating to outings, drugs and medication, medical emergencies and photographs. Parents must also sign a Special Permission form for the following: i) instructions re: allergies ii) medical treatment procedures iii) special diets iv) any other special circumstance 12. CONFIDENTIALITY: Due to the nature of this program, the Transition Counsellor and Agency have access to privileged information about families. This information will be treated with the strictest of confidence. 13. HUMAN RIGHTS: The Children's Village, in the provision of this service has the opportunity to work with a variety of cultural, religious and ethnic groups. In order to create a climate of mutual respect and understanding among these groups, the agency operates in accordance with the Human Rights Code of Ontario which states that discrimination because of race, ancestry, place of origin, colour, ethnic origin and creed is prohibited. 14. BEHAVIOUR POLICY: Transitions Programs are run for the benefit and enjoyment of all children. Should a child’s behaviour disrupt the program or jeopardize the safety of other children he or she may be withdrawn from the program. At the discretion of the Children’s Village, the child may not be permitted to return to the program.Submit RegistrationPlease do not fill in this field.