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) 583-3963

[email protected]

Fill Out The Form Below To Register Your Child

"*" indicates required fields

Step 1 of 3

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

Has your child been registered been with MaxECS previously?*

Yes

Child's Information

Child's Full Name*

First Middle Last

Gender*

Male

Female

*Gender as per birth certificate

Child's Date of Birth*

YYYY

This field is hidden when viewing the form

Age As Of August 31

Year

Month

Day

Required Documents

Canadian Identification Documentation*

YES - I am uploading a copy of the child’s Canadian identification documentation

NO - I agree to provide the child's Canadian identification documentation by October 31.

I am uploading*

Please provide a copy of your child’s Canadian identification documentation*

Accepted file types: pdf, jpg, png, Max. file size: 50 MB.

NOTE: Documentation must be provided to MaxECS admin by October 31. Please email to [email protected].

Parent / Guardian 1

Name*

First Last

Email*

Enter Email Confirm Email

Primary Phone*

Alternate Phone

Address*

Street Address City Province Postal Code

Parent / Guardian 2

Name

First Last

Enter Email Confirm Email

Primary Phone

Alternate Phone

Address

Street Address City Province Postal Code

Emergency Contact Information (Other than parents / guardians)

Emergency Contact Name*

First Last

Relationship To Child*

Primary Phone*

Email*

Enter Email Confirm Email

Address*

Street Address City Province Postal Code

Person Who Has Authorization To Pick Up The Child

Name

First Last

Phone

Relationship to Child

Child's Medical Information

Alberta Health Care Number (FOIP)*

My Child's Immunizations Are Up To Date*

Yes

Does the child have a family doctor and/or paediatrician*

Yes

Contact information for the child's family doctor and/or paediatrician*

Allergies

Medical Conditions That MaxECS Staff Should Be Aware Of

Has The Child Had A Recent Vision Test?*

Yes

Vision Test Results*

Has The Child Had A Recent Hearing Test?*

Yes

Hearing Test Results*

School / Children Information

School / Childcare The Child Will Attend In September For The 2026/2027 School Year*

School Phone*

School Email*

Choose Days The Child Will Be Attending School In 2026/2027*

Monday

Tuesday

Wednesday

Thursday

Friday

Start Time*

Hours

Minutes

AM/PM

End Time*

Hours

Minutes

AM/PM

School Address*

Street Address City Province Postal Code

Teacher Name

Director / Owner Name

Referring Therapist

Additional Information You Feel MaxECS Staff Should Know? Additional Concerns?

Program Hour Requirements*

To qualify for funding a child must attend a minimum of 12 hrs/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 AB ED requirements are met.

The child attends preschool for the minimum requirements of 12 hrs/week (475 hrs/year).

The child attends preschool but DOES NOT MEET the minimum requirements of 12 hrs/week (475 hrs/year).

I understand that I will be contacted by a MaxECS staff member to discuss options for programming hours.

The Child's Language(s)

Do you have a concern with the child's primary language?*

Yes

Languages spoken at home and percentage of time spoken:*

If more than 1 language, what do you consider the child’s primary language?*

If more than 1 language, how much English exposure has the child had?*

(i.e., at home, in the community, through daycare, preschool, older siblings, etc.)?

0-6 mos

6-12 mos

12+ mos

Access To Funding Through Alberta Education:

Please agree with each statement below.

I am requesting MaxECS to apply for Program Unit Funding (PUF) or Mild/Moderate funding (M/M) or English as an Additional Language (EAL) funding.*

Agree

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) in order to obtain PUF, M/M or EAL Funding.*

Agree

I consent to the child receiving assessment and services with MaxECS contracted 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

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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 30 days written notice to the MaxECS Education Director if I decide to withdraw my child from MaxECS programming.*

Agree

I understand that if the child is not on time for the therapy session, their 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

If the child will be absent for an extended period of time, between September and end of June, I will notify MaxECS staff immediately.*

Agree

I will attend the scheduled 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 and discuss records, assessments, therapy reports and progress for my child to their receiving school.*

Agree

I give permission to MaxECS to share and discuss records, assessments, therapy reports and progress for my child with other professional team members (including, but not limited to; Speech Language Therapists, Occupational Therapists, Physical Therapists, Physicians, Pediatricians, Educators, Psychologists, etc.)*

Agree

Please Sign Below

Name*

First Last

Signature*

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