FUNDING REGISTRATION FORM

2026-2027

For Alberta Education Funding through

Bragg Creek Education Services Association (BCESA)

CHILD'S INFORMATION

Child's First Name

Child's Middle Name

Child's Last Name

Child's Preferred Name

Gender

Birthday

Year

Month

Day

Country of Birth

Province (if Canada)

Citizenship Status:

Copy of child’s Birth Certificate or Canadian Documents will be provided to BCESA.

First Nations, Métis & Inuit Eligibility (FNMI) if applicable, please specify:

PARENT/GUARDIAN'S INFORMATION

#1 Parent / Guardian Name

Mailing Address

Physical Address

Email

Phone

Other Phone

#2 Parent / Guardian Name

Mailing Address

Physical Address

Email

Phone

Other Phone

SCHOOL/PROGRAM CHILD ATTENDS

School/Daycare Attending

Classroom Teacher or Director

School/Daycare Address

Phone

PARENT CONSENT

I (parent/guardian), give permission to BCESA to release records, assessments, therapy reports, Individualized Program Plans and any other PUF or MM service documents for my child (mentioned above), to their receiving school/daycare. I am requesting BCESA to apply for Program Unit Funding (PUF) or Mild/Moderate (MM) Funding, and I authorize BCESA to apply and administer PUF or MM funding for my child:

Parent Signature

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Date

Parent Signature

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POLICIES CONFIRMATION

Program Unit Funding (PUF) and Mild Moderate Funding (MM)

Administered by Bragg Creek Education Services Association (BCESA)

Child's Name:

By checking the boxes below, I (the child's legal parent/guardian) am in agreement with each of these policies which are expectations of PUF/MM as administered by: School Authority - Bragg Creek Education Services Association; assigned School - The Little Schoolhouse, Box 226, Bragg Creek, AB T0L0K0 403-949-3939.

I understand that to obtain PUF or MM funding, I must sign the PUF/MM application and provide a copy of my child's birth certificate (and, if applicable, documentation supporting my ability to work/study in Canada if my child was not born in Canada) no later than September 25th.

I understand that eligibility for Alberta Education funding includes assignment of an Alberta Student Number and a Special Education Code, and that all BCESA documentation will be shared with Alberta Education.

I understand that my child must be registered and regularly attend a preschool, kindergarten, or daycare program in order to receive this funding. Mild Moderate children must be registered for 475 hours this school year (Sep-June) and PUF children must be registered for 300-400 hours/year (Sep-June). I acknowledge that lack of attendance in an educational setting may jeopardize my child's funding.

I agree to notify my child’s therapist if my child will be absent from a scheduled therapy session. I understand that missed sessions will not be rescheduled and my child will be seen at the next planned session.

I will inform my child's PUF/MM Coordinator if the assigned therapist does not attend a scheduled session.

If I decide to withdraw my child from the school or daycare, I will inform my child’s PUF/MM coordinator. Likewise, if I withdraw my child from the therapy program (PUF or MM service), I agree to provide at least one month’s written notice. I understand that alternatives will be discussed at that time.

I acknowledge that extended conversations with my child’s therapist may result in a reduction of therapy time. Each session includes 45 minutes of direct therapy and 15 minutes of debriefing. Additional interaction may be considered consultative and may be billed, thus reducing the therapy hours available to my child.

I agree to participate in the development and signing of my child’s Individualized Program Plan (IPP), according to their funding code:

• Mild/Moderate (Code 30): Sign IPP twice per year (November and June).

• Moderate Language Delay (Code 48 - PUF): Attend and sign IPP at least two meetings per year (October and June).

• Severe PUF (Codes 42, 44, 47): Attend and sign IPP at three meetings per year (October, February, and June).

Parent Signature

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Date

Parent Signature

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Date