Unit #5-2611 37th Avenue NE Calgary AB T1Y 5V7
(403) 277.0425
[email protected]

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About Us
- Our Team
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Services
Locations
Careers
Contact Us

TEST

Student Registration Form 2025- 2026

Dear Parents/Guardians,

As you begin the process of completing the registration package for the potential programming from KIN-DIR Education Foundation, we kindly request your utmost attention to detail. It is essential that every section of the package is filled out thoroughly and accurately.

Please note that an incomplete registration package cannot be processed. If any part of the package is left blank or is missing necessary information, the package will be considered incomplete. In such cases, to maintain the integrity of our enrollment process and to ensure fairness for all applicants, the package will be returned to you for completion.

This measure is in place to ensure that we have all the required information to best support your child's educational and administrative needs. Your cooperation in this matter is greatly appreciated and is crucial in facilitating a smooth and efficient registration process.

We understand that filling out registration documents can be time-consuming. However, complete, and accurate information is vital for us to provide the highest standard of education and care for your child. Should you have any questions or require assistance in completing the package, please do not hesitate to contact us at 403.277.0425.

Thank you for your attention and cooperation in this important matter. We look forward to potentially welcoming your child to our KIN-DIR Education Foundation programming.

Sincerely,

Cavell Burley

CHILD INFORMATION

First Name *

Middle Name

Last Name *

Child's Preferred Name *

Gender *MaleFemaleUndefined

Date of Birth *

Day

Month

Year

Place of Birth *

Citizenship *Canadian CitizenLegal Resident

Primary Address (Please include postal code and city.) *

CHILD IDENTIFICATION

CHILD IDENTIFICATION

Please attach a copy of your birth certificate, passport, or permanent residence confirmation.

Upload Documents (birth certificate, passport, permanent residence confirmation, temporary residence card) *

Drag and Drop (or) Choose Files

I have attached: *Birth CertificatePassportPermanent Residence ConfirmationTemporary Residence Card

PRESCHOOL/DAYCARE: My child will be attending the following location for the upcoming school year:

Name of Site *

Days of Attendance:

MondayAMPM

TuesdayAMPM

WednesdayAMPM

ThursdayAMPM

FridayAMPM

Times for 2024/25 School Year: Monday

Times for 2024/25 School Year: Tuesday

Times for 2024/25 School Year: Wednesday

Times for 2024/25 School Year: Thursday

Times for 2024/25 School Year: Friday

Time Attended at Preschool/Daycare: (# of years)

Languages spoken at site:

Have there been any areas of concerns:YesNo

Describe the concern:

TRANSPORTATION REQUIRED:YESNO

SITE *

MEDICAL INFORMATION

MEDICAL INFORMATION: My child’s medical information is:

Alberta Health Care Number:

Family Doctor:

Dr. Office Phone #:

Dr. Office Address:

Asthma *YESNO

Regular Medications? *YESNO

Medication Name:

Dietary Restrictions? *YESNO

Specify:

Medical/Allergy: *YESNO

Epi Pen Required: *YESNO

For which allergy or medical condition:

Does your child have any other health related issues or medical history that we should know? *YESNO

Explain (any other health related issues or medical history that we should know about):

Hearing

Hearing

Has your child had:

Has your child had:

Frequent ear infections: *YESNO

A Hearing Screen at Birth: *YESNO

Hearing Screen at Birth Test Result:PASSFAIL

Describe Test Result:

Diagnosis:

A Hearing Test: *YESNO

Hearing Test Date:

Day

Month

Year

Hearing Test result:PASSFAIL

Describe Test Result:

Hearing Test Diagnosis:

Vision

Has your child had:

A Vision Test: *YESNO

Vision Test Date

Day

Month

Year

Visual deficits: (e.g., myopia, astigmatic, etc.)

Therapy

Therapy

Has your child ever been assessed and/or treated by therapist: (e.g., a Physiotherapist, Psychologist, Occupational Therapist or Speech Language Pathologist) *YESNO

If YES, please identify:

Physiotherapy: Name of Program

Physiotherapy: Date of Services

Physiotherapy: Results/Outcomes/Diagnosis

Psychology: Name of Program

Psychology: Date of Services

Psychology: Results/Outcomes/Diagnosis

Occupational Therapy: Name of Program

Occupational Therapy: Date of Services

Occupational Therapy: Results/Outcomes/Diagnosis

Speech Language Therapy: Name of Program

Speech Language Therapy: Date of Services

Speech Language Therapy: Results/Outcomes/Diagnosis

PARENT/GUARDIAN

PARENT/GUARDIAN

Parent/Guardian *MotherFatherGuardian

First Name *

Last Name *

Primary Address (Please include postal code and city.) *NOTE: Please ensure that if another person(s) is picking up your child other than the names listed above, we need to be informed through writing the person(s) full name before they pick up your child and they will need to present picture identification to confirm their identity.

Phone/Cell Number *

Email *

Preferred Method of contact *PhoneEmail

Are there any Separation Agreements/Court Orders/Access/Custody Agreements pertaining to this child? *YESNO

Please attach the copies of agreements.

Drag and Drop (or) Choose Files

I have attached copies.YESNO

PARENT/GUARDIAN

PARENT/GUARDIAN

Parent/GuardianMotherFatherGuardian

First Name

Last Name

Primary Address (Please include postal code and city.)NOTE: Please ensure that if another person(s) is picking up your child other than the names listed above, we need to be informed through writing the person(s) full name before they pick up your child and they will need to present picture identification to confirm their identity.

Phone/Cell Number

Email

Preferred Method of contactPhoneEmail

Are there any Separation Agreements/Court Orders/Access/Custody Agreements pertaining to this child?YESNO

Please attach the copies of agreements.

Drag and Drop (or) Choose Files

I have attached copies.YESNO

EMERGENCY CONTACT(S)

EMERGENCY CONTACT(S)

We require an alternate person who can pick your child up if parents cannot be reached

EMERGENCY CONTACT #1

EMERGENCY CONTACT #1

First Name *

Last Name *

Relationship to child *

Email *

Phone Number *

Primary Address (Please include postal code and city.) *

EMERGENCY CONTACT #2

EMERGENCY CONTACT #2

First Name *

Last Name *

Relationship to child *

Email *

Phone Number *

Primary Address (Please include postal code and city.) *NOTE: Please ensure that if another person(s) is picking up your child other than the names listed above, we need to be informed through writing the person(s) full name before they pick up your child and they will need to present picture identification to confirm their identity.

CONSENT FOR SERVICES & CONSULTATION

CONSENT FOR SERVICES & CONSULTATION

Child’s Legal Full Name

Child’s Legal Full Name

First Name *

Middle Name *

Last Name *

Consent *

I give consent for my child to participate in KIN-DIR Education Foundation’s screening process. I understand that this screening may include individual or small group sessions conducted by Learning Support Teachers (LST), Speech Language Pathologists, Occupational Therapists, Physiotherapists, Psychologists and /or their support staff. The purpose of those sessions is to provide more detail about my child’s learning and to determine whether additional assessment is recommended. I have been advised and acknowledge that screening results may be used to assist with access to resources and/or government funding. However, I understand that a screening completed by KIN-DIR Education Foundation does not necessarily mean that my child will receive early intervention services or guarantee that skills will be improved. It has been explained to me and I understand that the decision to access services can be postponed to a later date and that there are alternative options available. If areas of delay are identified, I give consent to Kin-Dir Education Foundation to complete a formal assessment with my child. I understand that I will be contacted by phone/email to discuss the results and will then have the option to set up an in-person meeting if I have further inquiries. Should funding be granted based on screening and assessment results, I understand and give consent to KIN-DIR Education Foundation employees, which may include therapists and support staff, along with the Learning Support Teacher (LST) to provide Early Childhood Services by way of direct one to one support in the classroom, therapy, consultation, and referral. I understand and acknowledge that the information gathered through services provided is considered private, confidential, and protected by law. I understand and acknowledge that information pertaining to my child or myself will not be released without my written consent or knowledge. KIN-DIR Education Foundation is obligated to release information, if requested, by Calgary Child and Family Services and the City of Calgary Police Department. I also acknowledge and understand that a copy of all student information will be added to my child’s Cumulative File housed in a locked environment at KIN-DIR Education Foundation’s main office. I understand and give consent for relevant information to be shared with my child’s preschool/daycare: so that targeted and individual strategies can be implemented in the Preschool/Daycare Name classroom and interventions or therapeutic support be applied more consistently. I understand and acknowledge that I may withdraw this consent at any time and that this signed consent for services and consultation form will only remain valid for the current school year.

Completed by *

Date *

Month

Day

Year

Signature *

signing your signature here

HOME LANGUAGE QUESTIONNAIRE

HOME LANGUAGE QUESTIONNAIRE

Do not complete if only English is spoken in the home.

Child’s Legal Full Name

Child’s Legal Full Name

First Name

Middle Name

Last Name

What languages are spoken at home?

What is your child’s first language?

What language(s) does your child use most often?

What language does your child understand best?EnglishOthers

Specify the language

My child uses both/multiple languages well.YESNO

Does your child have difficulty understanding their first language?YESNO

Do you have concerns regarding your child’s ability to ask for things or tell you things?YESNO

Please explain:

How often does your child hear English at home?Almost Always (90-100%)Most of the time (70-90%)Often (50 – 70%)Some of the time (30-50%)Rarely (0-30%)

Was your child born in Canada?YESNO

How long have they lived in Canada? (Number of Years)

Does your child have any siblings?YESNO

Ages of siblings?

If your child is playing with a sibling, what language do they use to play together?

How has your child learned English? (Please select all that apply)From family since birthFrom family after moving to CanadaFrom brothers/sistersFrom TVFrom preschool/daycare/day homeOther

Please specify

CHILD HISTORY

CHILD HISTORY

Child’s Legal Full Name

Child’s Legal Full Name

First Name

Middle Name

Last Name

BIRTH HISTORY

Please check all that apply.Full term BirthUse of Forceps and/or SuctionNatural DeliveryC-SectionPreterm:

Birth Weight:

Number of Gestational Weeks:

Difficult or Complicated BirthYESNO

Describe:

Has your child ever been hospitalized?YESNO

Describe: (Neonatal Intensive Care, surgeries, illness)

EARLY MILESTONES HISTORY

At what age did your child babble (e.g. babba)?

At what age did your child use their first words (e.g. ball, kitty)?

At what age did your child, use two-word phrases (e.g. more milk)?

At what age did your child use full sentences (e.g. I like the blue car.)?

At what age did your child sit unsupported (by themselves)?

At what age did your child crawl on hands and knees (YES or NO)?

At what age did your child bum scoot (YES or NO)?

At what age did your child walk without support (by themselves)?

At what age did your child feed themselves using their fingers?

At what age did your child use utensils to eat?

CURRENT ABILITIES

CURRENT ABILITIES

Toilet Training:

Toilet Training:

Please select ALL that APPLY. My child…Wears diapersWears Pull-upsKnows when they are wetPees in the toiletAsks to go to the bathroomIndependently wipes themselves

CURRENT ABILITIES (CONTINUATION)

CURRENT ABILITIES (CONTINUATION)

Dressing:

Dressing:

Can your child dress themselves?YESNO

Can your child undress themselves?YESNO

Can your child undo Buttons?YESNO

Can your child undo Zippers?YESNO

Can your child do up Buttons?YESNO

Can your child do up Zippers?YESNO

Attention:

Attention:

Please select ALL that APPLY. My child…Makes good eye contactPoints at thingsTurns to look at me when I speakWaits patientlyCan copy what I do

Emotion and Behavior

Emotion and Behavior

Does your child have any social, emotional, or behavioral concerns?AnxietySadnessSpending too much time aloneOver excitedAngerAttention and focusSocial and play skillsDaily living skills

Please share more details about the specific social, emotional, or behavioral problems you've selected.

Additional Services

Additional Services

If your child has a diagnosis, have you accessed services through FSCD? (Family Supports for Children with Disabilities)YESNO

Do you have any support through Alberta Health Services (AHS)?YESNO

Name:

Do you have any support through Community Programs?YESNO

Is hard to understand when they speak?

Name:

Do you have any support through other service providers?YESNO

Name:

CURRENT AREAS OF NEED

CURRENT AREAS OF NEED

Please select ALL that APPLY. My child…

Please select ALL that APPLY. My child…

Describe:

Has troubles following directions and/or answering questions?

Describe:

Has a hard time joining in activities with other children?

Describe:

Has a hard time sitting still?

Describe:

Sometimes throws things or uses their body physically when they are angry or frustrated?

Describe:

Has a hard time working with their hands (e.g., colouring, using scissors, etc.)?

Describe:

Struggles with daily living skills (e.g., toileting, dressing themselves, etc.)?

Describe:

Sometimes chokes on food and/or is a picky eater?

Describe:

Is sometimes clumsy, and will trip or fall occasionally?

Describe:

Walks on their tippy-toes, or walks with their toes pointed inwards?

Describe:

Has difficulties with motor skills (e.g., jumping, hopping, running, balancing, coordination)?

Describe:

CURRENT AREAS OF NEED (CONTINUATION)

CURRENT AREAS OF NEED (CONTINUATION)

Does your child sometimes get frustrated when he/she cannot get their ideas across to others?YESNO

Please explain:

Is your child hard to understand?Yes 25% of the timeYes 50% of the timeYes 75% of the timeYes 90-100% of the time

Is your child understood by a stranger?Yes 25% of the timeYes 50% of the timeYes 75% of the timeYes 90-100% of the time

Is your child using different words?Yes 25% of the timeYes 50% of the timeYes 75% of the timeYes 90-100% of the time

Can your child answer questions?NeverRarelySometimesOftenAlways

Can your child understands directions?NeverRarelySometimesOftenAlways

Can your child asks for things?NeverRarelySometimesOftenAlways

Can your child speak in sentences?NeverRarelySometimesOftenAlways

Can your child use a variety of words?NeverRarelySometimesOftenAlways

Is there any family history for speech language or learning difficulties?YESNO

Please explain: (e.g. dad was late to talk; a first cousin stuttered)

Is there a family history of motor difficulties?YESNO

Please explain: (e.g. muscle weakness; toe walking; W-sitting; spina bifida; muscular dystrophy)

Do you have any safety concerns for your child?YESNO

Please explain: (e.g. do they trip often or struggle with balance/coordination?)

Does your child run away from you in stores, parking lots, etc.?YESNO

Please explain:

(403) 277.0425
[email protected]

Unit #5-2611 37th Avenue NE Calgary AB T1Y 5V7

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