ELECTRONIC FUNDING APPLICATION FORM - PUF/MM/ELL

Child Name*
Date of Birth*
Gender*

Max. file size: 20 MB.
*max file size - 20MB jpg or pdf

Parent / Guardian

Parent / Guardian Name*
Primary Address*
Where child resides
Address
If different than child's address

Emergency Contact Information

This is a person who could come to pick up your child in the case of illness or emergency if the school is unable to reach the parent.
Emergency Contact Name*
Address*

Child's Medical Information

***FCB will not administer medication without written authorization from the legal guardian. A special form is required.
Has your child had a recent vision test?*
Has your child had a recent hearing test?*

Immunizations

Please Check the Immunizations That Your Child Has Received
My Child's Immunizations Are Up-To-Date

Early Learning Program Child Will Attend September 2022 - June 2023

School Start Time*
:
School End Time*
:
School Address*
Is your child registered with any other school or preschool program?*
I give permission to Foothills Creative Beginnings Preschool and ECS Association to release records, assessments and therapy reports form my child to their receiving school.*
I authorize Foothills Creative Beginnings to apply for and administer Program Unit Funding, Mild/Moderate or English Language Learner funding:*
Date*

If you have any questions or concerns please call 403.478.8618

I give permission to Foothills Creative Beginnings Preschool and ECS Association to release records, assessments and therapy reports for my child to their receiving school.


Program Unit Funding (PUF) and Mild/Moderate Funding (M/M) administered by Foothills Creative Beginnings (FCB) Policies Confirmation

I understand that Alberta Education requires that my child participates in 475 hours of teacher director instruction for M/M or ELL funding and 300 400 hours for PUF. (PUF hours are dependent on age)*
Attendance: My child must be registered and regularly attend an Early Learning program, at least 3 days per week, (minimum 9 hours per week) in order to receive this funding. Lack of attendance in an educational setting can jeopardize my child's funding.*
I understand that to achieve these hours I will be required to participate in home-based programming, community programming and therapy.*
I understand that I will be required to attend Individual Program Plan (IPP) meetings during the school year.*
To obtain PUF, M/M, ELL Funding I must sign the PUF, M/M or ELL application and provide a copy of my child's birth certificate (and documentation that supports my ability to work in Canada, if my child was not born in Canada).*
I will provide 24 hours notice to my therapist, if my child will miss their therapy session. I must let my therapists know if my child will be unable to attend a session. I will be allowed one no-show appointment; all others, I may be required to pay a $50 short notice cancellation fee if FCB incurs a charge due to the short notice cancellation/no show.*
I will notify my child's Early Learning Coordinator if my child's therapist did not show to the scheduled therapy time.*
I will let my child's teaching assistant and teachers know if my child will be absent at preschool or kindergarten on any given day.*
I will provide one month's notice if I decide to withdraw my child from a therapy program (PUF, M/M or ELL Service) which alternatives will be discussed.*
I understand that if I am not on time for my therapy session, my session time will be reduced accordingly. (Therapy time will not be extended).*
For serious illness, I will provide a signed report from my child's doctor. It will be kept in a private file, and will be available to staff only, in case of any related emergency requiring staff assistance.*
I understand that by applying for this funding, my child will be registered with Alberta Education and be assigned Alberta Student Number (ASN). Assessments and IPP’s will become part of my child's student record.*
Date*

If you have any questions or concerns please call 403.478.8618