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  • 403-501-0019

Intake Form

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BELA Registration Intake

***As per licensing agreements, forms must be filled out completely with all fields addressed to complete registration intake*** If you are unable to complete the form, there is a "save and continue" option available at the bottom of the form. This option allows you to save the information you have already entered and come back later to complete the form. By using the save and continue option, you can avoid losing your progress and ensure that your information is saved.

Child's Information

Child's Name(Required)
(child must be 3 or 4 years old by Dec. 31, 2026)
Gender(Required)
Birth Certificate copy(Required)
Please bring a copy of their birth certificate to registration
Child’s Immunizations Up-to Date(Required)

Class Schedule

Below is the tentative class schedule for next year. You will be asked on your Intake Form to make a first choice and a second choice for the class your child will attend. In the event that you have chosen a class that is full, you will be given your second choice. BELA will only run full classes and reserves the right to make changes to the schedule if necessary and based on registrations. Please take note of class start and end times to ensure they work for your family’s schedule

3 Year Old Programs

4 Year Old Programs

Which Program will your child be attending(Required)
Please Select Childs Age(Required)

3 Year Old | 3 Hour Program

Please choose a first choice and a second choice for the class your child will attend.
3 Hour Programs | First Choice
First Choice
3 & 4 Hour Programs | Second Choice
Second Choice

3 Year Old | 4 Hour Program

Please choose a first choice and a second choice for the class your child will attend.
4 Hour Programs | First Choice
First Choice
3 & 4 Hour Programs | Second Choice
Second Choice

4 Year Old | 3 Hour Program

Please choose a first choice and a second choice for the class your child will attend.
3 Hour Programs | First Choice
First Choice
3 & 4 Hour Programs | Second Choice
Second Choice

4 Year Old | 4 Hour Program

Please choose a first choice and a second choice for the class your child will attend.
4 Hour Programs | First Choice
First Choice
3 & 4 Hour Programs | Second Choice
Second Choice

Family Information

Parent(s) &/or Guardian(s)
Mother’s Name:(Required)
Father’s Name:(Required)
Child lives with:(Required)
Address(Required)
Additional Street Address if applicable
Mailing Address
E Mail Address:(Required)
Consent(Required)

Emergency Contact

1.Emergency Contact (if parent(s) cannot be reached)(Required)
1.Address(Required)

Person(s) Authorized to Pick up Child from Preschool (other than parents/guardians listed previously

Please list the Relationship to Child and Phone Number for each that apply.
2.Person(s) Authorized Pickup
3.Person(s) Authorized Pickup
4.Person(s) Authorized Pickup

Information About Your Child

(particularly anaphylactic allergies, such as nuts)
please list any health conditions which may affect child in school (e.g. asthma, epilepsy, diabetes)
Has your child had an assessment or been seen by any of the following?
How did you learn about BELA?

Consent

INFORMATION LISTED IS TRUE(Required)
Provide Documentation(Required)
At registration I will bring copies of my child’s birth certificate, immunization record & Alberta Health Care card to BELA.
MY CHILD IS PHYSICALLY FIT.(Required)
My child is not suffering from any medical condition that might prevent them from participating in activities
Participation(Required)
a.participate in all of the activities organized by BELA; and
b. use all the play equipment owned or used by BELA; and
c.leave the school premises under the supervision of a staff member of BELA for walks in the neighbourhood; and to local parks;
d.participate in activities involving bus transportation under the supervision of a staff member of BELA.
Child Release Policy(Required)
No child will be released to a person other than a parent without authorization.
The Late Pick-up Policy(Required)
If you or a designated person fail to pick up your child within 10 minutes of the class end time, we will attempt to contact you through the following methods: 1) home phone 2) parents' mobile phones 3) work number(s) 4) emergency contact. If your child remains uncollected after an hour, we will notify the child protection department of social services.
Illness Policy(Required)
The Illness Policy states that in the event a child displays any signs or symptoms of illness while attending BELA the parent/guardian or emergency contact will be notified to arrange for the child's pickup promptly.
COVID-19 / GENERAL PANDEMIC FEE ADJUSTMENT & REFUND POLICY(Required)
I understand that BELA will not adjust fees or provide refunds for any short-term closure mandated by Alberta Health services or other government bodies. Fee adjustments and/or refunds will be issued only in the event of a long-term mandated closure lasting 1 month or greater, and would be issued on a monthly basis.
I CONSENT TO EMERGENCY MEDICAL TREATMENT FOR MY CHILD.(Required)
In an emergency, my child may need medical or surgical treatment. If an emergency occurs, every reasonable effort must first be made to contact me. If I cannot be reached, I give permission for the emergency medical treatment of my child. Any expense incurred for emergency medical treatment under this section will be my responsibility. The organizers may also make other decisions that are necessary for the care and protection of my child during any activity of BELA.
I CONSENT TO HEALTH CARE TREATMENT FOR MY CHILD.(Required)
Should the need arise, Program Staff at the Brooks Early Learning Academy may provide health care, and health care in the way of First Aid to my child.
CANCELLATION/WITHDRAWAL FROM THE ACTIVITIES OF BELA(Required)
I understand and agree that the $100.00 registration & materials fee that is included in my child’s tuition will not be refunded under any circumstance. I also understand and agree that should I wish to withdraw my child from BELA after the program commences, I am required to give 30 days written notice to BELA in order to avoid a one month payment penalty. Should I withdraw my child after January 1, I will not be entitled to a return of any of my fees. Tuition fees are payable for the full academic year and are not subject to adjustment for gradual entry, illness, absence, school closures in exceptional circumstances, or circumstances beyond the control of the school. BELA fees will not be pro-rated or adjusted for changes to program made by the parent that results in the child attending less time than their original fee agreement.
I AGREE NOT TO HOLD BELA, THE BOARD MEMBERS, THEIR OFFICERS, EMPLOYEES OR AGENTS RESPONSIBLE FOR ACCIDENTS.(Required)
When a child participates in an activity organized for preschool aged children there is always a risk of personal injury or death, and property damage or loss. I acknowledge that the organizers will not be able to fully supervise, care for, or control the Participants involved in preschool activities. If anything happens to my child or my child’s property in preschool activities, I agree not to hold those supervising the activity, BELA, the Board Members, and their Officers, Employees, or Agents responsible unless they have been grossly negligent. I realize that I am responsible for insuring my child and my child’s property for any loss.
I ACKNOWLEDGE THAT BELA DOES NOT ADMINISTER AND IS NOT RESPONSIBLE FOR ANY GOVERNMENT SUBSIDY OR GRANT PROGRAMS.(Required)
Any questions regarding these programs should be directed to the responsible government department. BELA has no prior knowledge of, or control over, any changes to subsidy or grant programs, the value of the amounts allocated, or the qualification criteria. If a government program is changed or cancelled, fees may be recalculated at any point in the year and are the responsibility of the registered family
Consent to display, publish and/or use the child’s photo(Required)
Consent to display, publish and/or use the child’s photo and/or video footage of the child in school related activities that are publicized in local media, the school website and in BELA promotional materials; including but not limited to: Photos used by local media, Website, Promotional Videos, Brochures, Print Ad Campaigns, Other Marketing Materials, As art/display in the school.
COLLECTION, USE & SHARING OF PERSONAL INFORMATION(Required)
I understand that all personal information collected through the registration process will be treated as confidential and stored securely to protect my personal privacy. I understand that certain information collected may be shared with the Government to provide education and/or child care services.
Please bring Birth Certificate, Alberta Health Care Number, & Immunization Records to registration.

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Address: #1- 560 Cassils Road E
Brooks AB
T1R 1M6
Phone:403-501-0019
Fax: 403-501-0025
Registered Charity # 83175 2308 RR0001
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