Afterschool Program - Provider Info

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Please keep your organization's information and your SD43 files up-to-date by filling out the form below (legal name, address, contact, instructors list, and insurance status)

Email *

Section 1 - Organization Info

Confirm Your Company's Legal Name *

If you do not have a registered company name and operating as a sole proprietorship, please put your full legal name (first/ middle/ last)

Confirm the Business Registration Number of your Organization or S.I.N. for Sole Proprietors. *

We collect and share this info with SD43 (School District # 43 Coquitlam) only for compliance and not used by any third parties for any purposes.

Examples:
- Organizations: 12345678 RC 0001 (or BC 0001)
- Sole Proprietors: 123-456-789

Confirm Your "Operating" Name, if Different from Your Legal Name

Confirm Your Organization's Legal Street Address *

Street address and unit number

Confirm - City *

Confirm - Postal Code *

Please Enter in this format: V1V1V1 (example)

Confirm - Mailing Address (optional) - If different from your primary address

Street address - City - Postal code

Skip this part if it's the same as previous.

Section 2 - Program Personnel Info

Who is the Primary Contact for Programs? *

Enter their full name below. Example: Joe Smith

Confirm the Primary Contact's Phone # *

We collect and share this info with SD43 (School District # 43 Coquitlam) and school partners who may request your programs.

Confirm the Primary Contact's Email *

We collect and share this info with SD43 (School District # 43 Coquitlam) and school partners who may request your programs.

List All Instructors & Personnel that will be Delivering Programs in SD43 *

Please include their Full Legal Names below in point forms on separate lines.

Example:

- Instructor #1 First/ Last Name

- Instructor #2 First/ Last Name

- (List all for SD43 programs)

Do ALL Instructors have valid CRC or have completed a new CRC? *

Yes - All have updated CRC and submitted to Afterschool Guide/ DWUL

No - We will complete a new Free Online CRC with Afterschool Guide/ DWUL

Other:

Section 3 - Liability Insurance Confirmation

Update: Starting in Fall 2022, Afterschool Guide & DWUL will assist SD43 in collecting liability insurance info from program providers and district partners and share copies with SD43.

Please confirm - Do you have both "School District # 43 Coquitlam" and "Do What U Luv Foundation" listed under your "Additional Insured" List? *

You can add both organizations under your "Additional Insured" list through your insurance broker agent for no additional costs.

Organization info:

1. School District # 43 Coquitlam - 1080 Winslow Ave, Coquitlam, BC, V3J 0M6

2. Do What U Luv Foundation - 204-3242 Westwood St., Port Coquitlam, BC, V3C 3L8

Yes - I have both already added and listed under "Additional Insured" and will email a copy of the page to: info@afterschool.guide

No - I will contact my Insurance Broker to add them as "Additional Insured" and will email a copy of the page to: info@afterschool.guide

Not Applicable - Requires additional insurance support

Please confirm your insurance policy number # here (if avail.)

A copy of your responses will be emailed to the address you provided.

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