2015/2016 P.A. DAY REGISTRATION FORM ONE PER CHILD

2015/2016 P.A. DAY REGISTRATION FORM
ONE PER CHILD
ACCOUNT NUMBER
Our full-day care runs from 7:30 am to 6:00 pm. Your child’s day will include organized activities,
snacks, and an off-site activity or special visitor. Children are supervised by qualified educators.
In September the off-site activities or special visitor information will be posted at your Program.
FEES PER P.A. DAY:
DATE OF P.A. DAY

Kindergarten Children $43.00

Gr. 1 and Older Children $40.00
Second and subsequent child(ren) 50%
off lowest fee.
If you are currently receiving financial
assistance, contact your Program
Coordinator if you have questions
about your fees.
PAYMENT OPTIONS:
(payment processed)
INITIAL TO
CONFIRM
CHOICES
DEADLINE FOR
REGISTRATION OR
WITHDRAWAL
October 2, 2015
(TVDSB only)
September 18, 2015
November 20, 2015
November 6, 2015
January 15, 2016
January 1, 2016
June 10, 2016
May 27, 2016
Pre-authorized Debit (PAD):
If you are signed up for PAD your fees will be directly withdrawn from your account on each P.A. Day
for which your child is registered.
Cheques:
If you are not signed up for PAD, a separate cheque must be submitted with this form for each P.A.
Day for which your child is registered.
Registrations cannot be processed until payment arrangements are received.
CANCELLATION:
Notice must be given to your Program Coordinator no later than two weeks prior to the P.A. Day.
Fees will be charged if the required notice is not given.
PLEASE NOTE: There is a minimum number of registrations required at each site. If the required
number is not met your child will be moved to an alternate location.
_______________________________________________
Child Name (Please Print)
___________________________________
Daytime Phone Number
_______________________________________________
School
I give permission for my child to attend the above initialed P.A. Day program(s), with transportation
provided by Murphy Bus Lines.
________________________________________________
Parent’s/Guardian’s Signature
___________________________________
Date
I acknowledge that emailing this form serves as my signature.
Return registration form and cheque(s) (if applicable) to your Program Coordinator by
e-mail, fax 519-471-5679, or submit to
London Children’s Connection, 346 Wonderland Rd S. N6K 1L3