(587) 583-3963
info@maxecs.org

Registration

Registering Your Child

Please complete the form below to register. If you have any issues or questions please don’t hesitate to reach out to us.

(825) 558-8078

info@maxecs.org

Fill Out The Form Below To Register Your Child

"*" indicates required fields

Child's Information

Child's Full Name*
Gender*
*Gender as per birth certificate
Child's Date of Birth*
Hidden
Age As Of August 31

Parent / Guardian 1

Name*
Email*
Address*

Parent / Guardian 2

Name
Email
Address

Emergency Contact Information

Emergency Contact Name*
Email*
Address*

Person Who Has Permission To Pick Up Your Child

Name

Child's Medical Information

My Child's Immunizations Are Up To Date*

School / Children Information

Choose Days Child Attends School*
Start Time*
:
End Time*
:
School Address*

Access To Funding Through Alberta Education:

Please agree with each statement below.
I am requesting Maximize Early Childhood Services apply for Program Unit Funding (PUF) or Mild/Moderate funding (M/M) or English Language Learning (ELL) funding.*
To obtain PUF, M/M or ELL Funding I must sign this PUF / M/M 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 consent to my child receiving assessment and services with therapists contracted by Maximize Early Childhood Services. These may include Speech-Language Therapists, Occupational Therapists, Physiotherapists and/or Behaviour Strategists.*
Attendance: My child must be registered and regularly attend a preschool/childcare or kindergarten program in order to receive this funding. Lack of attendance in an educational setting can jeopardize my child's funding.*
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 MECS incurs a charge due to the short notice cancellation/no show.*
I will notify my child's PUF / M/M Coordinator if my child's therapist did not show to the scheduled therapy time.*
I understand that extended conversations with my child's therapist could result in a reduction of therapy hours. Additional interaction may be considered consultative in nature and may be billed, thus reducing your child's therapy hours.*
I will let my child's teaching assistant and teachers know if my child will be absent at preschool, childcare or kindergarten on any given day.*
I will provide one month's notice if I decide to withdraw my child from a therapy program.*
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).*
In the unfortunate event that my child becomes seriously ill and is absent for an extended period, I will provide a signed report from my child's doctor to be included with the attendance record for Alberta Education.*
PUF ONLY: I will attend 3 - 1 hour Individual Program Plan (IPP) meetings during the year. Time for the meeting will be limited to one hour per meeting and will be scheduled at a time mutually convenient for the team.*
I give permission to Maximize Early Childhood Services to release records, assessments and therapy reports for my child to their receiving school.*
I give permission to Maximize Early Childhood Services to share records, assessments and therapy reports for my child with other team members.*

Required Documents

Max. file size: 300 MB.

Please Date & Sign

Name*
This field is for validation purposes and should be left unchanged.