(587) 583-3963
info@maxecs.net

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.net

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 MaxECS apply for Program Unit Funding (PUF) or Mild/Moderate funding (M/M) or English as an Additional Language (EAL) funding.*
To obtain PUF, M/M or EAL 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 and individuals contracted by MaxECS. These may include Speech-Language Therapists, Occupational Therapists, Physiotherapists and/or Behaviour Strategists.*
I understand my child must be registered in and attend regularly a licensed early learning program to receive this funding. Lack of attendance in an educational setting will put my child's funding and program at risk for withdrawal from AB ED funding. Attendance for children requiring 475 program hours, I understand that my child must be registered and regularly attend a licensed early learning program, at least 2 days per week, with a minimum of 6 hours of teacher-directed instruction per week to receive this funding. Lack of attendance in an educational setting will jeopardize my child's funding and be a cause for withdrawal.*
I understand that my child may be required to participate in additional programming that is scheduled outside of the program time my child attends their community program to ensure that they meet Alberta Educations minimum hours.*
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 MaxECS incurs a charge due to the short notice cancellation/no show.*
I will notify my child's PUF / M/M Certificated Teacher 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 education 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 MaxECS to release records, assessments and therapy reports for my child to their receiving school.*
I give permission to MaxECS to share records, assessments and therapy reports for my child with other professional team members. (eg; speech language therapists, occupational therapists, physical therapists, physicians, pediatricians, etc)*

Required Documents

Max. file size: 300 MB.

Please Date & Sign

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