Leduc Society for Christian Education
2024-2025 Preschool Registration
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Part 1: Student Information
Last name, First name (ie Doe, John) *
Date of Birth (MM, DD, YYYY)  Your child must be 4 years old by December 31, 2024 *
Gender *
Address *(Please provide Physical Location if address listed is R.R. or P.O.#): *
City: *
Postal Code: *
Allergies:
Other Health Concerns and/or Special Needs:
On-Going Medication:
Completed a Medical Authorization Form: *
Immunizations Up-to-Date: *
Covenant Family(see handbook): *
Part 2: Parent/Guardian Information
Parent/Guardian#1 - Last Name, First Name: *
Parent/Guardian #1 - Mailing Address: *
Please provide Physical Location if address listed above is R.R. or P.O.#: *
Parent/Guardian #1 - City: *
Parent/Guardian #1 - Postal Code: *
Parent/Guardian #1 - Home Phone: *
Parent/Guardian #1 - Cell Phone: *
Parent/Guardian #1 - Work Phone:
Parent/Guardian #1 - Email(email address that is checked regularly and is shareable): *
Parent/Guardian #1 - Relationship to Child: *
Parent/Guardian #2 - Last Name, First Name:
Parent/Guardian #2 - Mailing Address:
Please provide Physical Location if address listed above is R.R. or P.O.#:
Parent/Guardian #2 - City:
Parent/Guardian #2 - Postal Code:
Parent/Guardian #2 - Home Phone:
Parent/Guardian #2 - Cell Phone:
Parent/Guardian #2 - Work Phone:
Parent/Guardian #2 - Email:
Parent/Guardian #2 - Relationship to Child:
Part 3 : Emergency Contact Information (Note: Other than parents)
*Required for Licensing
Last Name, First Name: *
Mailing Address (Please provide Physical Location if address listed is R.R. or P.O#): *
City: *
Postal Code: *
Home Phone: *
Cell Phone: *
Relationship to Child: *
Part 4: Other Information
Registering for School Year : 2024-2025
Preferred Preschool Class: (may depend on enrollment numbers)   *Morning class is full* *
Part 5: Payment Information
No Application is complete until the application fee and is received.
If you have any questions or concerns, please contact Lisa Gatzke at lisa.gatzke.lsce@gmail.com
Fees
Application Fee: $50.00/Child (Due at time of application)
Supply Fee: $50.00/Child (Due September 1st, 2024)
Preschool Fee: $700.00/Child (Due September 1st, 2024)
*Please see options Below

Our program is eligible for the Affordability Grant.  Fees will be prorated accordingly.  Please just pay the $50 application fee and the rest will be invoiced to you in September.
Fee Payment Information: Check the appropriate Payment Option *
How would you like your invoice delivered? *
Preferred email address (if you choose to get your invoice emailed) *
We require  a Cleaning Deposit at time of Application
(Shredded at Year End if Tasks Completed)
Cleaning Deposit: $100.00/Child -  Credit Card Authorization Form (found here; ccs.blackgold.ca, under Preschool Registration)
Part 6: Parent Commitment
I/We will pay the amount in the method indicated above within the school year mentioned above. *
I/We give my child permission to use all the facilities at Covenant Christian School - gym, library, playground, etc. *
I/We give permission to use student's name, photo, video or comments in the preschool calendar, newsletters, other publications, for birthday recognition or on artwork or other material displayed at the school. *
I/We have read the Preschool Parent Handbook(found here: ccs.blackgold.ca, under Preschool Registration) and agree with the policies outlined within. *
I/We have read the "Accident & Illness" and "Administration of Medicine" policies of the Parent Handbook and give the responsible adult in charge of my child at CCS Preschool, permission to use the necessary measures in case of a medical emergency when immediate action must be taken. *
I/We have filled out the forms (medical, PAD & Credit Card forms) in the information package found here; ccs.blackgold.ca under Preschool Registration? *
Parent/Guardian Signature *
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