LEAP School Worker Form

Parents can register their child for one or both terms. Parents will be required to pay an administrative fee of $ 25 per term. Should there be multiple children from the same family registered for the program, the fee will be $25 for the first child, and $5 for each additional child PER TERM. Parents will be sent an invoice by email from the program supervisor prior to the start of the program.  
 
Eligibility:  
-    The student has been identified by an Ometz professional as at-risk of being negatively impacted by any or all the following factors due to family situations. These include single-parent families, low socio-economic status, recent immigrants, and families struggling with mental health issues, history of violence, abuse, or neglect in the home.
-    The student has a mild to moderate social skills deficit that impedes their ability to interact appropriately with peers and authority figures.
-    The student has mild to moderate emotional difficulties that impact their academic and/or social functioning.
-    The student is experiencing learning difficulties which impact their academic performance.
 
Should a child meet the above criteria for the programs, please follow this process to make a referral:
1.    Obtain verbal consent from parent to refer their child to the program (Please note referral does not guarantee acceptance into program).
2.    Fill out the form below
3.    Once child has been accepted into the program, you will be notified by email.
4.    The Jr. Middle or Sr. Program Coordinator will be contacting the parents to confirm acceptance to the program and will send an emergency contact and consent form**

 

Learning Enrichment After-School Program (LEAP) Worker Application
Person Completing Form
First name
Last name
E-mail
Relationship with the child
Student Information
First name
Last name
Gender
  
  
 
Date of birth
/ /
Address
City
Province
Postal Code/Zip
Name of School
Grade:
Is the student a returning LEAP participant?
  
Primary language spoken at home
    
    
 
Language in school
  
LEAP Criteria
 
 
 
 
 
 
Person Completing Form
Brief Description of Child’s Situation:
Comments:
First Name
Parent 1
Last Name
Parent 1
E-mail
Parent 1
Phone
Parent 1
First Name
Parent 2
Last Name
Parent 2
E-mail
Parent 2
Phone
Parent 2