{"id":1309,"date":"2020-01-31T13:53:26","date_gmt":"2020-01-31T13:53:26","guid":{"rendered":"http:\/\/wp.kidsconnection.ca\/?page_id=1309"},"modified":"2020-02-10T02:57:43","modified_gmt":"2020-02-10T02:57:43","slug":"registration-after-school","status":"publish","type":"page","link":"https:\/\/wp.kidsconnection.ca\/index.php\/registration-after-school\/","title":{"rendered":"Registration After School"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\"  style='background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;padding-top:0px;padding-right:25px;padding-bottom:25px;padding-left:25px;'><div class=\"fusion-builder-row fusion-row \"><div  class=\"fusion-layout-column fusion_builder_column fusion_builder_column_1_1 fusion-builder-column-0 fusion-one-full fusion-column-first fusion-column-last 1_1\"  style='margin-top:0px;margin-bottom:0px;'><div class=\"fusion-column-wrapper\" style=\"padding: 0px 0px 0px 0px;background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;\"   data-bg-url=\"\"><div id=\"erf_form_container_1360\" class=\"erf-container erf-contact erf-label-top erf-layout-one-column erf-style-rounded-corner\">\n        \n    \n         \n                    <div class=\"erf-content-above\">\n                Please fill out the registration form below for Before\/After School care or print the registration form by clicking <a style=\"color: green\" href=\"http:\/\/wp.kidsconnection.ca\/wp-content\/uploads\/2020\/03\/Registration-Form-After-School.pdf\"><b>here<\/b><\/a>.\r\n\r\n<em>Note: this is just an application form.\u00a0 This does not guarantee a spot in our program.\u00a0 Kids Connection will contact you by email to follow up.<\/em>            <\/div>\n            <form method=\"post\" enctype=\"multipart\/form-data\" class=\"erf-form erf-front-form\" data-parsley-validate=\"\" novalidate=\"true\" data-erf-submission-id=\"0\" data-erf-form-id=\"1360\">\n                <div class=\"erf-form-html\" id=\"erf_form_1360\">\n                    <div class=\"rendered-form\">\n                        <div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='Heading6' data-ref-id='header-nu9uzdfb' class='' >Child Information<\/h1><\/div><div class=\"erf-text form-group field-field-8z9KD8hjDo4bG0o erf-element-width-4\"><label for=\"field-8z9KD8hjDo4bG0o\" class=\"erf-text-label\">Child First Name<span class=\"erf-required\">*<\/span><\/label><input type='text' maxlength='50' required='required' class='form-control' name='field-8z9KD8hjDo4bG0o' data-ref-label='Child_First_Name' id='field-8z9KD8hjDo4bG0o'  \/><\/div><div class=\"erf-text form-group field-field-2dAVTPNMjgdCm7Z erf-element-width-4\"><label for=\"field-2dAVTPNMjgdCm7Z\" class=\"erf-text-label\">Child Middle Name<\/label><input type='text' class='form-control' name='field-2dAVTPNMjgdCm7Z' data-ref-label='Child_Middle_Name' id='field-2dAVTPNMjgdCm7Z'  \/><\/div><div class=\"erf-text form-group field-text-136505488239 erf-element-width-4\"><label for=\"text-136505488239\" class=\"erf-text-label\">Child Last Name<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' maxlength='50' class='form-control' name='text-136505488239' data-ref-label='Child_Last_Name' id='text-136505488239'  \/><\/div><div class=\"erf-text form-group field-field-NaiwIcxK69HxGYm erf-element-width-6\"><label for=\"field-NaiwIcxK69HxGYm\" class=\"erf-text-label\">Child's Address - Street Number and Name<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-NaiwIcxK69HxGYm' required='required' data-ref-label='Childs_Address Street' id='field-NaiwIcxK69HxGYm'  \/><\/div><div class=\"erf-text form-group field-field-Boeoar1DLlniQuA erf-element-width-6\"><label for=\"field-Boeoar1DLlniQuA\" class=\"erf-text-label\">Child's Address - City<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-Boeoar1DLlniQuA' required='required' data-ref-label='City' id='field-Boeoar1DLlniQuA'  \/><\/div><div class=\"erf-text form-group field-field-CuCko2L3oVzlagp erf-element-width-6\"><label for=\"field-CuCko2L3oVzlagp\" class=\"erf-text-label\">Child's Address - Province<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-CuCko2L3oVzlagp' required='required' data-ref-label='Province' id='field-CuCko2L3oVzlagp'  \/><\/div><div class=\"erf-text form-group field-field-xXkSrKZwCFkgyR3 erf-element-width-6\"><label for=\"field-xXkSrKZwCFkgyR3\" class=\"erf-text-label\">Child's Address - Postal Code<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-xXkSrKZwCFkgyR3' required='required' data-ref-label='Postal Code' id='field-xXkSrKZwCFkgyR3'  \/><\/div><div class=\"erf-text form-group field-field-SSE9WJLuoom6Lvq erf-element-width-3\"><label for=\"field-SSE9WJLuoom6Lvq\" class=\"erf-text-label\">Date of Birth<span class=\"erf-required\">*<\/span><\/label><input type='text' data-date-format='mm\/dd\/yy' class='form-control erf-date-field' name='field-SSE9WJLuoom6Lvq' required='required' data-ref-label='Date_of_Birth' id='field-SSE9WJLuoom6Lvq'  \/><\/div><div class=\"erf-text form-group field-field-TOimM2Kelk2lw8E erf-element-width-3\"><label for=\"field-TOimM2Kelk2lw8E\" class=\"erf-text-label\">School Attending in Fall<span class=\"erf-required\">*<\/span><\/label><input type='text' data-ref-label='School in Fall' class='form-control' name='field-TOimM2Kelk2lw8E' required='required' id='field-TOimM2Kelk2lw8E'  \/><\/div><div class=\"erf-select form-group field-field-W5gFVNujfqX3eTQ erf-element-width-3\"><label for=\"field-W5gFVNujfqX3eTQ\" class=\"erf-select-label\">School Grade (in fall)<span class=\"erf-required\">*<\/span><\/label><select class='form-control' name='field-W5gFVNujfqX3eTQ' required='required' data-ref-label='School_Grade_in_fall' id='field-W5gFVNujfqX3eTQ'  ><option value=\"\">Choose One<\/option><option selected value=\"Kindergarten\">Kindergarten<\/option><option value=\"Grade 1\">Grade 1<\/option><option value=\"Grade 2\">Grade 2<\/option><option value=\"Grade 3\">Grade 3<\/option><option value=\"Grade 4\">Grade 4<\/option><option value=\"Grade 5\">Grade 5<\/option><option value=\"Grade 6\">Grade 6<\/option><\/select><\/div><div class=\"erf-text form-group field-field-4mXys4kCRdIez3n erf-element-width-3\"><label for=\"field-4mXys4kCRdIez3n\" class=\"erf-text-label\">Current School Attending<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-4mXys4kCRdIez3n' required='required' data-ref-label='Current_School_Attending' id='field-4mXys4kCRdIez3n'  \/><\/div><div class=\"erf-text form-group field-field-tuKJ6ny0U4heMXy erf-element-width-6\"><label for=\"field-tuKJ6ny0U4heMXy\" class=\"erf-text-label\">Current Teacher's Name<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-tuKJ6ny0U4heMXy' required='required' data-ref-label='Current_Teachers_Name' id='field-tuKJ6ny0U4heMXy'  \/><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' class='spacer' data-ref-label='ref-cqvbTsEp' data-ref-id='ref-vA5m9i1I' >Separator<\/div><\/div><div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-NdSa4x5B' data-ref-id='ref-aQodZWMe' class='' >Parent Information<\/h1><\/div><div class=\"erf-text form-group field-field-vMRV3IKJo5x8sdv erf-element-width-4\"><label for=\"field-vMRV3IKJo5x8sdv\" class=\"erf-text-label\">Mother\/Guardian Full Name<\/label><input type='text' maxlength='50' class='form-control' name='field-vMRV3IKJo5x8sdv' data-ref-label='Mother_Full_Name' id='field-vMRV3IKJo5x8sdv'  \/><\/div><div class=\"erf-text form-group field-field-kbCU8ub0QAEESLm erf-element-width-4\"><label for=\"field-kbCU8ub0QAEESLm\" class=\"erf-text-label\">Relationship to Child<\/label><input type='text' data-ref-label='Relationship Mother' class='form-control' name='field-kbCU8ub0QAEESLm' id='field-kbCU8ub0QAEESLm'  \/><\/div><div class=\"erf-email form-group field-field-iZkeszwRZIVAqJd erf-element-width-4\"><label for=\"field-iZkeszwRZIVAqJd\" class=\"erf-email-label\">Mother Email<\/label><input type='email' class='form-control' name='field-iZkeszwRZIVAqJd' data-ref-label='Mother_Email' id='field-iZkeszwRZIVAqJd'  \/><\/div><div class=\"erf-tel form-group field-field-OULdMC7tnthOAmb erf-element-width-4\"><label for=\"field-OULdMC7tnthOAmb\" class=\"erf-tel-label\">Mother Home Phone #<\/label><input type='tel' class='form-control' name='field-OULdMC7tnthOAmb' enable-intl='1' data-ref-label='Mother_Home_Phone_' id='field-OULdMC7tnthOAmb'  \/><\/div><div class=\"erf-tel form-group field-field-cVO3YDvdrXNhKsW erf-element-width-4\"><label for=\"field-cVO3YDvdrXNhKsW\" class=\"erf-tel-label\">Mother Work Phone #<\/label><input type='tel' class='form-control' name='field-cVO3YDvdrXNhKsW' enable-intl='1' data-ref-label='Mother_Work_Phone_' id='field-cVO3YDvdrXNhKsW'  \/><\/div><div class=\"erf-tel form-group field-field-XnDPufOTVUT1cg2 erf-element-width-4\"><label for=\"field-XnDPufOTVUT1cg2\" class=\"erf-tel-label\">Mother Cell Phone #<\/label><input type='tel' class='form-control' name='field-XnDPufOTVUT1cg2' enable-intl='1' data-ref-label='Mother_Cell_Phone_' id='field-XnDPufOTVUT1cg2'  \/><\/div><div class=\"erf-text form-group field-field-dgWwhERNluq9ay4 erf-element-width-12\"><label for=\"field-dgWwhERNluq9ay4\" class=\"erf-text-label\">Mother Employer<\/label><input type='text' class='form-control' name='field-dgWwhERNluq9ay4' data-ref-label='Mother_Employer' id='field-dgWwhERNluq9ay4'  \/><\/div><div class=\"erf-text form-group field-field-chU3hR47dPDfFjn erf-element-width-4\"><label for=\"field-chU3hR47dPDfFjn\" class=\"erf-text-label\">Father\/Guardian Full Name<\/label><input type='text' class='form-control' name='field-chU3hR47dPDfFjn' data-ref-label='Father_Full_Name' id='field-chU3hR47dPDfFjn'  \/><\/div><div class=\"erf-text form-group field-field-64uB4trtkPNjFvQ erf-element-width-4\"><label for=\"field-64uB4trtkPNjFvQ\" class=\"erf-text-label\">Relationship to Child<\/label><input type='text' data-ref-label='Relationship Father' class='form-control' name='field-64uB4trtkPNjFvQ' id='field-64uB4trtkPNjFvQ'  \/><\/div><div class=\"erf-email form-group field-field-nqNcO6QB3mztJKB erf-element-width-4\"><label for=\"field-nqNcO6QB3mztJKB\" class=\"erf-email-label\">Father Email<\/label><input type='email' class='form-control' name='field-nqNcO6QB3mztJKB' data-ref-label='Father_Email' id='field-nqNcO6QB3mztJKB'  \/><\/div><div class=\"erf-tel form-group field-field-jNYrZ34uTWqpH5q erf-element-width-4\"><label for=\"field-jNYrZ34uTWqpH5q\" class=\"erf-tel-label\">Father Home Phone #<\/label><input type='tel' class='form-control' name='field-jNYrZ34uTWqpH5q' enable-intl='1' data-ref-label='Father_Home_Phone_' id='field-jNYrZ34uTWqpH5q'  \/><\/div><div class=\"erf-tel form-group field-field-RbunpHJwNqu9fFL erf-element-width-4\"><label for=\"field-RbunpHJwNqu9fFL\" class=\"erf-tel-label\">Father Work Phone #<\/label><input type='tel' class='form-control' name='field-RbunpHJwNqu9fFL' enable-intl='1' data-ref-label='Father_Work_Phone_' id='field-RbunpHJwNqu9fFL'  \/><\/div><div class=\"erf-tel form-group field-field-NryCYbHEpgA42gF erf-element-width-4\"><label for=\"field-NryCYbHEpgA42gF\" class=\"erf-tel-label\">Father Cell Phone #<\/label><input type='tel' class='form-control' name='field-NryCYbHEpgA42gF' enable-intl='1' data-ref-label='Father_Cell_Phone_' id='field-NryCYbHEpgA42gF'  \/><\/div><div class=\"erf-text form-group field-field-cpBfqZ1WEPU6HG3 erf-element-width-12\"><label for=\"field-cpBfqZ1WEPU6HG3\" class=\"erf-text-label\">Father Employer<\/label><input type='text' class='form-control' name='field-cpBfqZ1WEPU6HG3' data-ref-label='Father_Employer' id='field-cpBfqZ1WEPU6HG3'  \/><\/div><div class=\"erf-text form-group field-field-TuWgP93fBhlCVrG erf-element-width-12\"><label for=\"field-TuWgP93fBhlCVrG\" class=\"erf-text-label\">Status of Parents (i.e. together, separated, divorced, etc)<\/label><input type='text' data-ref-label='Text_Field28' class='form-control' name='field-TuWgP93fBhlCVrG' id='field-TuWgP93fBhlCVrG'  \/><\/div><div class=\"erf-text form-group field-field-xrEYLZ53kj0IjuF erf-element-width-6\"><label for=\"field-xrEYLZ53kj0IjuF\" class=\"erf-text-label\">Emergency Contact Full Name (other than parent\/guardian)<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-xrEYLZ53kj0IjuF' required='required' data-ref-label='Emergency_Contact_Full_Name' id='field-xrEYLZ53kj0IjuF'  \/><\/div><div class=\"erf-tel form-group field-field-CuJD8CdhjL91Llo erf-element-width-6\"><label for=\"field-CuJD8CdhjL91Llo\" class=\"erf-tel-label\">Emergency Contact Phone #<span class=\"erf-required\">*<\/span><\/label><input type='tel' class='form-control' name='field-CuJD8CdhjL91Llo' required='required' enable-intl='1' data-ref-label='Emergency_Contact_Phone_' id='field-CuJD8CdhjL91Llo'  \/><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' class='spacer' data-ref-label='ref-3k0bXKER' data-ref-id='ref-Y7lJUaCT' >Separator<\/div><\/div><div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-mz3rroSy' data-ref-id='ref-XvHnnBZS' class='' >Pickup Permission<\/h1><\/div><div class=\"erf-richtext erf-element-width-12\"><div data-non-input='1' data-ref-label='ref-IZl3ncnj' data-ref-id='ref-SQdHVMI5' class='erf-rich-text' ><p><strong><em>I give permission for the following people to pick up my child from Kids Connection (note: photo id will be required for picking up a child).<\/em><\/strong><\/p><\/div><\/div><div class=\"erf-text form-group field-field-BGf5hOlXQNpskF6 erf-element-width-4\"><label for=\"field-BGf5hOlXQNpskF6\" class=\"erf-text-label\">Pickup 1 Name<\/label><input type='text' class='form-control' name='field-BGf5hOlXQNpskF6' data-ref-label='Pickup_1_Name' id='field-BGf5hOlXQNpskF6'  \/><\/div><div class=\"erf-text form-group field-field-wnCyjutitKGTG5j erf-element-width-4\"><label for=\"field-wnCyjutitKGTG5j\" class=\"erf-text-label\">Pickup 1 Relationship to Child<\/label><input type='text' class='form-control' name='field-wnCyjutitKGTG5j' data-ref-label='Pickup_1_Relationship_to_Child' id='field-wnCyjutitKGTG5j'  \/><\/div><div class=\"erf-tel form-group field-field-c42WgtR3w2OmUoz erf-element-width-4\"><label for=\"field-c42WgtR3w2OmUoz\" class=\"erf-tel-label\">Pickup 1 Phone #<\/label><input type='tel' class='form-control' name='field-c42WgtR3w2OmUoz' enable-intl='1' data-ref-label='Pickup_1_Phone_' id='field-c42WgtR3w2OmUoz'  \/><\/div><div class=\"erf-text form-group field-field-QZzGTiX2bXFhl4N erf-element-width-4\"><label for=\"field-QZzGTiX2bXFhl4N\" class=\"erf-text-label\">Pickup 2Name<\/label><input type='text' class='form-control' name='field-QZzGTiX2bXFhl4N' data-ref-label='Pickup_2Name' id='field-QZzGTiX2bXFhl4N'  \/><\/div><div class=\"erf-text form-group field-field-UIYPDT1Cpgt0zIR erf-element-width-4\"><label for=\"field-UIYPDT1Cpgt0zIR\" class=\"erf-text-label\">Pickup 2 Relationship to Child<\/label><input type='text' class='form-control' name='field-UIYPDT1Cpgt0zIR' data-ref-label='Pickup_2_Relationship_to_Child' id='field-UIYPDT1Cpgt0zIR'  \/><\/div><div class=\"erf-tel form-group field-field-7cP7KlEJI4mrEFf erf-element-width-4\"><label for=\"field-7cP7KlEJI4mrEFf\" class=\"erf-tel-label\">Pickup 2 Phone #<\/label><input type='tel' class='form-control' name='field-7cP7KlEJI4mrEFf' enable-intl='1' data-ref-label='Pickup_2_Phone_' id='field-7cP7KlEJI4mrEFf'  \/><\/div><div class=\"erf-text form-group field-field-WLQs0lLjLZh9Qnc erf-element-width-4\"><label for=\"field-WLQs0lLjLZh9Qnc\" class=\"erf-text-label\">Pickup 3 Name<\/label><input type='text' class='form-control' name='field-WLQs0lLjLZh9Qnc' data-ref-label='Pickup_3_Name' id='field-WLQs0lLjLZh9Qnc'  \/><\/div><div class=\"erf-text form-group field-field-VkBRhEo17Urxjdg erf-element-width-4\"><label for=\"field-VkBRhEo17Urxjdg\" class=\"erf-text-label\">Pickup 3 Relationship to Child<\/label><input type='text' class='form-control' name='field-VkBRhEo17Urxjdg' data-ref-label='Pickup_3_Relationship_to_Child' id='field-VkBRhEo17Urxjdg'  \/><\/div><div class=\"erf-tel form-group field-field-9w0gl6SlJkQJ7Jg erf-element-width-4\"><label for=\"field-9w0gl6SlJkQJ7Jg\" class=\"erf-tel-label\">Pickup 3 Phone #<\/label><input type='tel' class='form-control' name='field-9w0gl6SlJkQJ7Jg' enable-intl='1' data-ref-label='Pickup_3_Phone_' id='field-9w0gl6SlJkQJ7Jg'  \/><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' class='spacer' data-ref-label='ref-vXRw1eB3' data-ref-id='ref-u4svhTC2' >Separator<\/div><\/div><div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-cH6AjfZ7' data-ref-id='ref-MqRd9lsd' class='' >Health Information<\/h1><\/div><div class=\"erf-number form-group field-field-D4Q0clPigkw3rb4 erf-element-width-4\"><label for=\"field-D4Q0clPigkw3rb4\" class=\"erf-number-label\">Health Card Number<span class=\"erf-required\">*<\/span><\/label><input type='number' class='form-control' name='field-D4Q0clPigkw3rb4' required='required' data-ref-label='Health_Card_Number' id='field-D4Q0clPigkw3rb4'  \/><\/div><div class=\"erf-text form-group field-field-CewV0C1xjs8Inbn erf-element-width-4\"><label for=\"field-CewV0C1xjs8Inbn\" class=\"erf-text-label\">Name of Doctor<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-CewV0C1xjs8Inbn' required='required' data-ref-label='Name_of_Doctor' id='field-CewV0C1xjs8Inbn'  \/><\/div><div class=\"erf-tel form-group field-field-Q7VRPkLa410P8YD erf-element-width-4\"><label for=\"field-Q7VRPkLa410P8YD\" class=\"erf-tel-label\">Doctor's Phone #<span class=\"erf-required\">*<\/span><\/label><input type='tel' class='form-control' name='field-Q7VRPkLa410P8YD' required='required' enable-intl='1' data-ref-label='Doctors_Phone_' id='field-Q7VRPkLa410P8YD'  \/><\/div><div class=\"erf-text form-group field-field-w7ykrSZfkyXyUhS erf-element-width-12\"><label for=\"field-w7ykrSZfkyXyUhS\" class=\"erf-text-label\">Allergies<\/label><input type='text' class='form-control' name='field-w7ykrSZfkyXyUhS' data-ref-label='Allergies' id='field-w7ykrSZfkyXyUhS'  \/><\/div><div class=\"erf-textarea form-group field-field-EFk4zg9k06dX1S1 erf-element-width-6\"><label for=\"field-EFk4zg9k06dX1S1\" class=\"erf-textarea-label\">Medical Conditions<\/label><textarea class='form-control' name='field-EFk4zg9k06dX1S1' rows='3' cols='1' data-ref-label='Medical_Conditions' id='field-EFk4zg9k06dX1S1' ><\/textarea><\/div><div class=\"erf-textarea form-group field-field-8n5JZJyogDJcGr0 erf-element-width-6\"><label for=\"field-8n5JZJyogDJcGr0\" class=\"erf-textarea-label\">Physical Conditions<\/label><textarea class='form-control' name='field-8n5JZJyogDJcGr0' data-ref-label='Physical_Conditions' id='field-8n5JZJyogDJcGr0' ><\/textarea><\/div><div class=\"erf-textarea form-group field-field-UItShFzzpKWjxds erf-element-width-6\"><label for=\"field-UItShFzzpKWjxds\" class=\"erf-textarea-label\">Behavioural\/Social Conditions<\/label><textarea class='form-control' name='field-UItShFzzpKWjxds' data-ref-label='BehaviouralSocial_Conditions' id='field-UItShFzzpKWjxds' ><\/textarea><\/div><div class=\"erf-textarea form-group field-field-Q6aCleom3cf4iN2 erf-element-width-12\"><label for=\"field-Q6aCleom3cf4iN2\" class=\"erf-textarea-label\">Is there any other information about the care of your child that we need to know?<\/label><textarea class='form-control' name='field-Q6aCleom3cf4iN2' data-ref-label='Is_there_any_other_information_about_the' id='field-Q6aCleom3cf4iN2' ><\/textarea><\/div><div class=\"erf-richtext erf-element-width-12\"><div data-non-input='1' data-ref-label='ref-YAGSWiJY' data-ref-id='ref-rIU0Sl1W' class='erf-rich-text' ><p><strong>Emergency Medical Consent<\/strong>: I hereby give permission for the Supervisor and staff of Kids Connection to act on my<br \/>behalf in obtaining and\/or authorizing medical treatment if an emergency arises and I cannot be contacted by telephone.<br \/>I understand that any treatment would be on the advice of a qualified medical doctor. Children are not to<br \/>bring medication to center. Staff do not administer drugs.<\/p>\n<p><em>Medical information is collected solely to support your child's accommodation needs and will not be used to determine program eligibility.<\/em><\/p><\/div><\/div><div class=\"erf-text form-group field-field-CZWCWsyiEkxAyKB erf-element-width-6\"><label for=\"field-CZWCWsyiEkxAyKB\" class=\"erf-text-label\">Signature<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-CZWCWsyiEkxAyKB' placeholder='Type Signatory Name Here' required='required' data-ref-label='Signature' id='field-CZWCWsyiEkxAyKB'  \/><\/div><div class=\"erf-text form-group field-field-aa1QEKNcbS2Oqzf erf-element-width-6\"><label for=\"field-aa1QEKNcbS2Oqzf\" class=\"erf-text-label\">Date<span class=\"erf-required\">*<\/span><\/label><input type='text' placeholder='Choose Today&#039;s Date' data-date-format='mm\/dd\/yy' class='form-control erf-date-field' name='field-aa1QEKNcbS2Oqzf' required='required' data-ref-label='Date' id='field-aa1QEKNcbS2Oqzf'  \/><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' class='spacer' data-ref-label='ref-mVVcrR7C' data-ref-id='ref-EApOA6B4' >Separator<\/div><\/div><div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-ZrRQHafL' data-ref-id='ref-IZGzVJvY' class='' >Fee Information and Payment Options<\/h1><\/div><div class=\"erf-radio-group form-group field-field-F2CM0OACWVV2fmV erf-element-width-12\"><label for=\"field-F2CM0OACWVV2fmV\" class=\"erf-radio-group-label\">Program Option (prices subject to change)<span class=\"erf-required\">*<\/span><\/label><div class=\"radio-group\"><div class=\"radio\"><input id=\"field-F2CM0OACWVV2fmV-0\" name='field-F2CM0OACWVV2fmV' required='required' class='form-control' data-ref-label='Program_Option'  type=\"radio\" value=\"After-School Only\" \/><label for=\"field-F2CM0OACWVV2fmV-0\">After-School Only ($335\/month; 2nd child $305\/month)<\/label><\/div><div class=\"radio\"><input id=\"field-F2CM0OACWVV2fmV-1\" name='field-F2CM0OACWVV2fmV' required='required' class='form-control' data-ref-label='Program_Option'  type=\"radio\" value=\"Before\/After School\" \/><label for=\"field-F2CM0OACWVV2fmV-1\">Before\/After School ($360\/month; 2nd child $335\/month)<\/label><\/div><div class=\"radio\"><input id=\"field-F2CM0OACWVV2fmV-2\" name='field-F2CM0OACWVV2fmV' required='required' class='form-control' data-ref-label='Program_Option'  type=\"radio\" value=\"PD\/Snow Days\" \/><label for=\"field-F2CM0OACWVV2fmV-2\">PD Days\/Snow Days Only ($40\/day)<\/label><\/div><div class=\"radio\"><input id=\"field-F2CM0OACWVV2fmV-3\" name='field-F2CM0OACWVV2fmV' required='required' class='form-control' data-ref-label='Program_Option'  type=\"radio\" value=\"March Break Day Camp\" \/><label for=\"field-F2CM0OACWVV2fmV-3\">March Break Day Camp ($150\/wk or $75\/wk if enrolled in after school program)<\/label><\/div><\/div><\/div><div class=\"erf-checkbox-group form-group field-field-KA7ZhMqLbRtNfFG erf-element-width-12\"><label for=\"field-KA7ZhMqLbRtNfFG\" class=\"erf-checkbox-group-label\">Add PD\/Storm Days\/Delays\/Early Closures<\/label><div class=\"checkbox-group\"><div class=\"checkbox\"><input id=\"field-KA7ZhMqLbRtNfFG-0\" name='field-KA7ZhMqLbRtNfFG[]' class='form-control' multiple='1' data-ref-label='Add_PDStorm_DaysDelaysEarly_Closures'  type=\"checkbox\" value=\"Add PD\/Storm Days\" \/><label for=\"field-KA7ZhMqLbRtNfFG-0\">Add PD\/Storm Days ($20\/day)<\/label><\/div><div class=\"checkbox\"><input id=\"field-KA7ZhMqLbRtNfFG-1\" name='field-KA7ZhMqLbRtNfFG[]' class='form-control' multiple='1' data-ref-label='Add_PDStorm_DaysDelaysEarly_Closures'  type=\"checkbox\" value=\"Add Delays\" \/><label for=\"field-KA7ZhMqLbRtNfFG-1\">Add Delays ($5\/day if After-School Only; $4\/day if Before\/After School)<\/label><\/div><div class=\"checkbox\"><input id=\"field-KA7ZhMqLbRtNfFG-2\" name='field-KA7ZhMqLbRtNfFG[]' class='form-control' multiple='1' data-ref-label='Add_PDStorm_DaysDelaysEarly_Closures'  type=\"checkbox\" value=\"Add Early Closures\" \/><label for=\"field-KA7ZhMqLbRtNfFG-2\">Add Early Closures ($10\/day)<\/label><\/div><\/div><\/div><div class=\"erf-text form-group field-field-EoC2br45XXeZWKu erf-element-width-2\"><label for=\"field-EoC2br45XXeZWKu\" class=\"erf-text-label\">Start Date<span class=\"erf-required\">*<\/span><\/label><input type='text' data-ref-label='Start Date' data-date-format='mm\/dd\/yy' class='form-control erf-date-field' name='field-EoC2br45XXeZWKu' required='required' id='field-EoC2br45XXeZWKu'  \/><\/div><div class=\"erf-radio-group form-group field-field-49eiLChAvf8YXMU erf-element-width-3\"><label for=\"field-49eiLChAvf8YXMU\" class=\"erf-radio-group-label\">Payment Method<span class=\"erf-required\">*<\/span><\/label><div class=\"radio-group\"><div class=\"radio\"><input id=\"field-49eiLChAvf8YXMU-0\" name='field-49eiLChAvf8YXMU' required='required' class='form-control' data-ref-label='Payment_Method'  type=\"radio\" value=\"E-Transfer\" \/><label for=\"field-49eiLChAvf8YXMU-0\">E-Transfer<\/label><\/div><div class=\"radio\"><input id=\"field-49eiLChAvf8YXMU-1\" name='field-49eiLChAvf8YXMU' required='required' class='form-control' data-ref-label='Payment_Method'  type=\"radio\" value=\"Subsidy\" \/><label for=\"field-49eiLChAvf8YXMU-1\">Subsidy<\/label><\/div><\/div><\/div><div class=\"erf-radio-group form-group field-field-sX4Fy7D5ZIej8oA erf-element-width-3\"><label for=\"field-sX4Fy7D5ZIej8oA\" class=\"erf-radio-group-label\">Payment Frequency<span class=\"erf-required\">*<\/span><\/label><div class=\"radio-group\"><div class=\"radio\"><input id=\"field-sX4Fy7D5ZIej8oA-0\" name='field-sX4Fy7D5ZIej8oA' required='required' class='form-control' data-ref-label='Payment_Frequency'  type=\"radio\" value=\"Bi-Weekly\" \/><label for=\"field-sX4Fy7D5ZIej8oA-0\">Bi-Weekly<\/label><\/div><div class=\"radio\"><input id=\"field-sX4Fy7D5ZIej8oA-1\" name='field-sX4Fy7D5ZIej8oA' required='required' class='form-control' data-ref-label='Payment_Frequency'  type=\"radio\" value=\"Monthly\" \/><label for=\"field-sX4Fy7D5ZIej8oA-1\">Monthly<\/label><\/div><\/div><\/div><div class=\"erf-text form-group field-field-KbkLs8VGt8ocCws erf-element-width-4\"><label for=\"field-KbkLs8VGt8ocCws\" class=\"erf-text-label\">If subsidized, what is the parent share?<\/label><input type='text' class='form-control' name='field-KbkLs8VGt8ocCws' placeholder='Enter parent share here' data-ref-label='If_subsidized_what_is_the_parent_share' id='field-KbkLs8VGt8ocCws'  \/><\/div><div class=\"erf-text form-group field-field-3vuv3bnDWSuJz00 erf-element-width-6\"><label for=\"field-3vuv3bnDWSuJz00\" class=\"erf-text-label\">Name to Go On End-of-Year Receipt<\/label><input type='text' data-ref-label='Name for Receipt' class='form-control' name='field-3vuv3bnDWSuJz00' id='field-3vuv3bnDWSuJz00'  \/><\/div><div class=\"erf-button form-group field-button-18224875277 erf-element-width-12\"><button type='submit'class='btn btn-success'name='button-18224875277'data-erf-btn-pos='left'data-ref-label='Submit_Your_Registration_Form'id='button-18224875277'>Submit Your Registration Form<\/button><\/div>                    <\/div> \n                <\/div>    \n\n                <div class=\"erf-external-form-elements\">\n                    \n                    \n                    \n\n                    \n                                        <div class=\"erf-errors\" style=\"display:none\">\n                        <span class=\"erf-errors-head erf-error-row\">Error occured. Please confirm your data and submit again:<\/span>\n                        <div class=\"erf-errors-body\">\n                                                    <\/div> \n                    <\/div>\n\n                <\/div>\n                <!-- Contains multipage Next,Previous buttons -->\n                <div class=\"erf-form-nav clearfix\"><\/div> \n\n                <!-- Single page form button -->\n                <div class=\"erf-submit-button clearfix\"><\/div>\n\n\n                <input type=\"hidden\" name=\"erform_id\" value=\"1360\" \/>\n                <input type=\"hidden\" id=\"erform_submission_nonce\" name=\"erform_submission_nonce\" value=\"e208fb6078\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1309\" \/>                <input type=\"hidden\" name=\"action\" value=\"erf_submit_form\" \/>\n\n            <\/form>\n            \n<\/div>\n<div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1309","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/pages\/1309","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/comments?post=1309"}],"version-history":[{"count":5,"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/pages\/1309\/revisions"}],"predecessor-version":[{"id":1507,"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/pages\/1309\/revisions\/1507"}],"wp:attachment":[{"href":"https:\/\/wp.kidsconnection.ca\/index.php\/wp-json\/wp\/v2\/media?parent=1309"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}