Transitions Registration Form | Children's Village

Form Overview

This form is to be completed by families to enrol their school age children in our summer program.

D. Roy Kennedy Public School
919 Woodroffe Avenue
8:00am to 5:00 pm
Jr. Program July 4th to August 25th
Sr. Program July 4th to August 25th

Confederation Court Community House
2483 Wakley Rd.
8:30 am to 4:30 pm
Jr. Program July 4th to August 25th

St-Augustine School
1009 Arnot Road 8:00am to 5:00 pm
Jr. Program July 4th to August 25th
Sr. Program July 4th to August 25th

FEES: COST OF PROGRAM: $300.00 per 2-week session

The Payment Options are:
Full Fee
Ontario Works / Ontario Disability Support Program
Other

A. Child Registration

Please complete all required fields.

Child 1:

First Name

Last Name

Gender Identity *

Date of Birth *

Allergies

Indicate any special care requirements that your child may have e.g. Medical conditions, learning disability, A.D.D

Start Time *

Hours

Minutes

End Time *

Hours

Minutes

Gender:

Date Of Birth:

Hours Of Care:

Preferred Location:

Child 1 Dates

July 4th - July 15thJuly 18th - July 29thAugust 1st - August 12thAugust 15th - August 26th

I want to register a second child

Yes

Child 2:

First Name

Last Name

Gender Identity *

Date of Birth *

Allergies:

Indicate any special care requirements that your child may have e.g. Medical conditions, learning disability, A.D.D:

Hours of Care:

Start Time *

Hours

Minutes

End Time *

Hours

Minutes

Please Select Your Program *Junior Program (Ages 5-7)Senior Program (Ages 8-12)

Preferred Location *D. Roy Kennedy Public SchoolConfederation Court Community House

Preferred Location *D. Roy Kennedy Public School

Session Dates Required *

July 4th to July 15thJuly 18th to July 29thAugust 1st to August 12thAugust 15th to August 26th

Gender:

Date Of Birth:

Hours Of Care:

Preferred Location:

Child 2 Dates

July 4th - July 15thJuly 18th - July 29thAugust 1st - August 12thAugust 15th - August 26th

Payment Status *Full Fee - Payment is due prior to the start of your camp sessions – (cheques or cash payment only)Other (i.e. ODSP / Ontario Works)

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 camp.

Have you applied to the City of Ottawa Centralized Waiting List?YesNoNot Applicable

If Other, please indicate: *Child care subsidy must be approved prior to child attending camp.

B. Contact Information

Please complete all required fields.

Primary Contact Name *

Primary Email *

Parent/Guardian #1

First name *

Last Name *

Home Phone *

Business Phone

Home Address

Postal Code

Business Address

Postal Code

Parent/Guardian #2

First name

Last Name

Home Phone

Business Phone

Home Address

Postal Code

Business Address

Postal Code

C. Emergency Contact Person

Please complete all required fields.

Name *

Home Phone *

Work Phone *

Address *

Relationship *

D. Responsibilities for Parents Using "Transitions"

HOURS OF CARE/ABSENTEEISM: *Parents must advise the Transition Counsellor if the child is going to be absent or late.
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.
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.
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.
AGENCY INVOLVEMENT: Parents are advised to report any concerns or complaints regarding the Transitions program. We would also enjoy hearing your positive feedback.
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.
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)
LUNCH/SNACK/: Parents must provide a nut-free lunch and snack for their children.
OTHER: Parents must ensure that children come dressed appropriately for the weather and are provided with sunscreen.
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.
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.
WORKPLACE VIOLENCE, HARASSMENT & ABUSE POLICY: The Occupational Health and Safety Act, states that every person should be able to work without fear of violence or harassment in a safe and healthy workplace. The Children’s Village has a “Zero” tolerance policy for physical, sexual, emotional, verbal, psychological abuse or any form of neglect or harassment. This policy applies to employees, parents/guardians, volunteers, children, visitors and independent contractors.
ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT: In keeping with “The Accessibility for Ontarians with Disabilities Act (2005)”, the Children’s Village recognizes its obligation to ensure that programs and services offered by the Children’s Village are accessible to people with disabilities.
INCLUSION & EQUITY POLICY: The Children’s Village of Ottawa-Carleton supports the principles of social justice whereby children of all abilities are valued and included in all aspects of the Centre and the community.
All children and families have a right to the same opportunities for participation, acceptance and belonging regardless of gender, age, socio-economic status, race, language, beliefs, additional needs and family structure or lifestyle. All children, families, educators, students, volunteers and visitors are treated with respect, and appreciated as individuals with unique abilities, skills and knowledge. The Centre recognizes and values the differences and similarities that exist in children, families, educators
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.
DISCHARGE POLICIES: The following are possible conditions which could necessitate the possible discharge of a child from our Program:
- Behaviour exhibited by the child of an intensity and frequency that could be considered harmful to the child, the staff, other children in the program, or to the Child Care environment.
- Inability of the program to meet a child’s needs.
- Failure by a parent or parents to meet their financial obligations to the program over an extended period of time.
- Intentional disregard by parent(s) to comply with the policies and procedures outlined by the Child Care program.
- Publicly stated disparaging remarks on, but not limited to, social media that are made by a parent about the agency or staff.

E. Release and Permission Agreements

Please complete all required fields.

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. *YesNo

I give permission for my child/children to be photographed or filmed for training or promotional purposes on occasion during the period they are enrolled in the program. *YesNo

I give permission for my child/children to attend daily outings within the city limits as may be planned by the Transitions group and to have a substitute counselor when needed. *YesNo

By signing below, I acknowledge that I have read and understand the responsibilities of Parent are using Transitions and agree to abide by the terms and conditions thereof.

Signature of Parent *

Date *