Admissions & Enrollment Form | Beacon Heights School ECS

Enrollment Date

ECS Start Date

Child Information

Child’s First Name

Child’s Last Name

Sex

Male Female

Date of Birth

Age at ECS Commencement:

ECS

Full Time Part Time

Home Address

City

Postal Code

Copy of Birth Certificate Attached

YES NO

Upload Birth Certificate

Parent / Guardian Information

Mother

Name

Address

City

Postal Code

Phone

Father

Name

Address

City

Postal Code

Phone

Emergency Contacts & Authorizations

Primary Emergency Contact

Name

Relation with Child

Address

City

Postal Code

Phone

Secondary Emergency Contact (Optional)

Name

Relation with Child

Address

City

Postal Code

Phone

I authorize the Beacon Heights ECS staff to take whatever emergency medical measures are deemed necessary for the protection of my child while he/she is in their ECS. I understand this authorization includes calling a physician, implementing his instructions, and transporting the child to the hospital if a parent or guardian cannot reasonably be located. I agree to be responsible for the cost of such an emergency.

Permission for Photographs for Use in ECS

YES NO

Access Permissions for Pickup and Drop-off

Names of Individuals with Full Access

Name of Individuals with No Access

Child Profile & Family Information

Goals for the Year

Interests, Likes, Dislikes, Family Changes

Toilet / Sleeping / Social Habits

Languages Spoken at Home

Cultural Traditions & Holidays

Parent Willingness to Volunteer in ECS

YES NO

Medical Information

Alberta Health Card Number

Family Doctor’s Details (If Available)

Name

Address

Phone

Immunization Status

YES NO

Past Illnesses

YES NO

If Yes, Details

Diagnosed Medical Conditions

YES NO

If Yes, Details

Food Restrictions

YES NO

If Yes, Details

Allergies

YES NO

Severity

Mild Severe

If Yes, Details

Beacon Heights, as an approved ECS, in partnership with Outside the Box, provides early intervention screening to identify developmental areas in which your child may require additional support, such as speech and language, fine or gross motor, regulation, behavioral and classroom support.

Early Childhood Services (ECS) refers to programming offered by school authorities during preschool and kindergarten years and meets the diverse needs of young children and their families. In ECS programs, young children participate as active learners within developmentally appropriate learning experiences and develop knowledge, understanding and skills that lay the foundation for subsequent learning.

Screening Process

Completed by a multidisciplinary team including certificated teachers, speech-language pathologists, occupational therapists and behavioral therapists.
Takes between 10–20 minutes to complete.
Screening occurs during class time (while attending preschool, kindergarten or childcare).
Will help determine if our multidisciplinary team services may be recommended for your child.

Following Screening

Results and recommendations will be shared with parents/guardians and the school/daycare staff.

By filling out the consent form below, you are walking the first step towards Early Childhood Services to support your child’s development and educational needs.

Child Information

Child’s First Name

Child’s Last Name

Sex

Male Female

Date of Birth

Parent / Guardian Information

Mother

Name

Address

City

Postal Code

Phone

Father

Name

Address

City

Postal Code

Phone

Has your child ever been assessed by

Speech-Language Pathologist Occupational Therapist Psychologist None

If Yes, Details

Does your child have a medical diagnosis that may impact learning?

YES NO

Permission to Screen: Beacon Heights ECS provides early intervention screening to identify developmental areas in which your child may require additional support, such as speech and language, fine or gross motor and/or regulation, and behavior.

I/We give permission for my child to be screened by the Outside the Box early intervention team.

YES NO

Permission to proceed to assessment: Sometimes, during screening, the therapists determine a need for assessment. If a need for more information is determined during screening, I give permission for the speech-language therapist, occupational therapist and/or behavioral therapist to assess my child. The assessment determines if your child qualifies for early intervention grants from Alberta Education.

I/We give permission for my child to be screened by the Outside the Box early intervention team.

YES NO

Permission to proceed to registration: The assessment results will indicate ECS funding eligibility.

I/we give Beacon Heights ECS permission to apply for PUF or Mild Moderate funding, based on my child’s assessment results and needs

YES NO

Please describe any areas of concern you may have about your child’s development or social and emotional growth.

Has your child received any therapies (speech/language, occupational therapy, physical therapy, or psychology) before? If so, which therapies, and when?

If your child has attended preschool or daycare, describe how they responded to the experience.

Note: The information disclosed within this application form is used for Beacon Heights ECS registration purposes only and will be kept confidential.

Enroll Your Child at Beacon Heights ECS

Enrollment Form