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. (587) 583-3963info@maxecs.netFill Out The Form Below To Register Your Child "*" indicates required fields Child's InformationChild's Full Name* First Middle Last Gender* Male Female *Gender as per birth certificateChild's Date of Birth*YYYYYYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MMMM123456789101112DDDD12345678910111213141516171819202122232425262728293031This field is hidden when viewing the formAge As Of August 31YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031Parent / Guardian 1Name* First Last Email* Enter Email Confirm Email Primary Phone*Alternate PhoneAddress* Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent / Guardian 2Name First Last Email Enter Email Confirm Email Primary PhoneAlternate PhoneAddress Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact InformationEmergency Contact Name* First Last Relationship To Child*Primary Phone*Email* Enter Email Confirm Email Address* Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Person Who Has Permission To Pick Up Your ChildName First Last PhoneRelationship to ChildChild's Medical InformationAlberta Health Care Number (FOIP)*My Child's Immunizations Are Up To Date* Yes No AllergiesHas Your Child Had A Recent Vision Test? If So, Date?Has Your Child Had A Recent Hearing Test? If So, Date?Medical Conditions That MaxECS Staff Should Be Aware OfSchool / Children InformationSchool / Childcare My Child Will Attend In September For The 2025/2026 School Year*School Phone*School Email* Choose Days Child Attends School* Monday Tuesday Wednesday Thursday Friday Start Time* Hours : Minutes AM PM AM/PM End Time* Hours : Minutes AM PM AM/PM School Address* Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Teacher NameDirector / Owner NameReferring TherapistAdditional Information You Feel MaxECS Staff Should Know? Additional Concerns?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.* Agree To obtain PUF, M/M or EAL Funding I must sign this application and will provide a copy of my child's Canadian identification documentation (and documentation that supports my ability to work in Canada, if my child was not born in Canada).* Agree I consent to my child receiving assessment and services with therapists and individuals provided by MaxECS. These may include Speech-Language Therapists, Occupational Therapists, Physiotherapists and/or Behaviour Strategists.* Agree I understand my child must be registered in and attend regularly a licensed early learning program to receive this Alberta Education (AB ED) provided funding. Lack of attendance in an educational, licensed setting will put my child's funding and program at risk for withdrawal from AB ED funding.* Agree 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. To qualify for AB ED funding a child who attends a program part time must attend a minimum of 12 hours per week of teacher directed instruction in their registered program. If they do not meet this requirement, MaxECS will offer program hours at another location in addition to the registered program hours to ensure hourly requirement is sufficient for AB ED criteria.* Agree 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.* Agree I will notify my child's PUF / M/M Certificated Teacher if my child's therapist did not show to the scheduled therapy time.* Agree I will let my child's education assistant and teachers know if my child will be absent from preschool, childcare or kindergarten on any given day.* Agree I will provide one month's notice to the Education Director if I decide to withdraw my child from a therapy program.* Agree 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).* Agree 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 MaxECS to be accountable for the attendance required for AB ED.* Agree I will attend 3 Individual Program Plan (IPP) meetings during the year. Meetings will be scheduled at a time mutually convenient for the team.* Agree I give permission to MaxECS to release records, assessments and therapy reports for my child to their receiving school.* Agree I give permission to MaxECS to share records, assessments and therapy reports for my child with other professional team members. (e.g.; Speech Language Therapists, Occupational Therapists, Physical Therapists, Physicians, Pediatricians, etc.)* Agree Required DocumentsCanadian Identification Documentation* YES - I am uploading a copy of my child’s Canadian identification documentation NO - I agree to provide my child's Canadian identification documentation by October 31. NOTE: Documentation must be provided to MaxECS admin by October 31, 2025. Please email to donna@maxecs.net. I am uploading*Please make a selectionCanadian birth certificateCanadian passportCanadian citizenship documentationCanadian permanent resident card, both sidesValid Canadian visitor visaValid Canadian parental work visaPlease provide a copy of your child’s Canadian identification documentation*Max. file size: 300 MB.Please Date & SignName* First Last Signature*CommentsThis field is for validation purposes and should be left unchanged.
