604-498-3233 | info@surreychristian.com | www.surreychristian.com

SUMMER CARE REGISTRATION 2022

Join us for our summer care program offered at the Cloverdale Campus only (5950 179 Street). With field trips and plenty of outdoor play in this summer camp-like setting, our program will include something for everyone to enjoy.

Field trips will be Tuesdays and Thursdays unless otherwise indicated. Please note the schedule below, including the field trips, are tentative and SCS reserves the right to make changes to this schedule depending on availability, COVID restrictions and/or weather conditions.

If your child has a diagnosis, and/or requires a support worker during the regular school year, Surrey Christian School has the right to determine whether he/she will be a good fit for the program with or without extra support. If applicable, please indicate details in the medical section below.

-Children entering grades 1-7 this fall are eligible to register. (Please note there is limited space for grades 6&7.) -Summer care is limited to 30 attendees daily. Waitlists will be available.
-Dates: June 20 - August 19
-Times: 8:00 am - 5:00 pm daily

Please be sure to read the Out of School Care Handbook to be informed of our policies and procedures.

Today's date * +

STUDENT DETAILS

Student legal first name *

Student last name *

Student common name (if applicable)

Child's birthdate * +

Grade entering Sept. 2022 *

Language spoken at home *

SUMMER CARE SCHEDULE

Week 1

Dates: June 20-24 (This week is only available to current out-of-school-care children.)

Trips: Bear Creek Park, Fleetwood Park

Week 1 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145)

Week 1 - If part time indicate which days

Week 2

Dates: June 27 - June 30 (closed Friday, July 1)

Trips: Redwood Park, Hawthorne Park

Week 2 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145)

Week 2 - If part time indicate which days

Week 3

Dates: July 4-8

Trips: Queens Park, Crescent Beach

Week 3 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145)

Week 3 - If part time indicate which days

Week 4

Dates: July 11-15

Trips: Unwin Park, Hume Spray Park

Week 4 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145)

Week 4 - If part time indicate which days

Week 5

Dates: July 18-22

Trips: Centennial Beach, Redwood Park

Week 5 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145

Week 5 - If part time indicate which days

Week 6

Dates: July 25-29

Trips: Fleetwood Park, Hawthorne Park

Week 6 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145

Week 6 - If part time indicate which days

Week 7

Dates: August 2-5 (closed Mon., August 1)

Trips: Queens Park, Bear Creen Park

Week 7 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145

Week 7 - If part time indicate which days

Week 8

Dates: August 8-12

Trips: Hume Spray Park, Crescent Beach

Week 8 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145

Week 8 - If part time indicate which days

Week 9

Dates: August 15-19

Trips: Unwin Park, Centennial Beach

Week 9 -- I would like to register my child

Full time ($230)

2 days ($100)

3 days ($145)

Week 9 - If part time indicate which days

HOUSEHOLD INFORMATION

Primary phone number *

Primary email address *

Parent/guardian first name *

Parent/guardian last name *

Family street address *

Unit/Apartment #

City *

Province *

Postal code *

HEALTH

BC Personal Health Number *

Name of family doctor

Doctor phone number

Please specify any known allergies or medical conditions of which we should be aware.

Is the student currently taking any medication on a regular basis? If yes please provide details. *

Yes

No No

EMERGENCY CONTACTS

Please enter at least 1 and up to 2 names of people who have authorization to pick up your child, or whom we can contact in the event of an emergency and we cannot reach a parent.

First and last name of emergency contact/person allowed to pick up your child. *

Relationship to student *

Phone number *

2. First and last name of a second emergency contact/person allowed to pick up your child.

Relationship to student

Phone number

Name of persons other than emergency contacts listed above who may pick up your child from summer care

CONSENTS

Field Trip Consent

Please read the Acknowledgement of Risk regarding student field trips.

Acknowledgement of Risk

I consent to my child going on field trips and supervised walks in the neighbourhood during Summer Care 2022. *

Yes

No

Photograph Publishing Consent

During summer care photographs may be taken of various student activites. The scohol onlu publishes first names of students.

I consent to my child's photograph being published in the school newsletter, other school-related publications or on the school's website. *

Yes

No

Medical Treatment Consent

In case of an emergency where parents cannot be contacted I authorize the principal or school representative to contact the family doctor or take the necessary steps to ensure the health and safety of my child. *

Yes

No

FINANCIAL COMMITMENT

I understand that 30 days notice is required for withdrawal to receive a refund. *

Yes

I understand that changes to my summer care registration can me made up until May 31. Any changes thereafter will be subject to a $75 change fee. *

Yes

Enter number of weeks beside the desired category and click "Current total" below. You need to enter a zero beside categories you will not be registering for. *

	Full time ($230)
	2 days/week ($100)
	3 days/week ($145)

Current Total:

$0.00

Fee payment *

My banking information is on file with the finance office. Please debit my account for the monthly fees on June 1, July 1 and August 1.

I will submit a pre-authorized debit form (see link below). Please debit my account for the monthly fees on June 1, July 1 and August 1.

Link to Pre-authorized Debit Form

Sign below to authorize the withdrawal of funds from your account for summer child care fees as outlined above.

clear

ATTACHMENTS

1. Please upload a current photo of your child.

2. Please upload a copy of immunization record

3. Please upload a copy of birth certificate.

English	Korean	Mandarin
Cantonese	Spanish	Other Other