OUT OF SCHOOL CARE REGISTRATION

Dear Parents and Guardians:

Children are natural learners and creation enjoyers of God’s world. Our mission at Surrey Christian Early Learning Centres is to offer safe, diverse, experiential learning opportunities to recognize the full potential and individuality of each child. We believe each child is created in the image of God and has an important and unique role to play in sharing His redeeming love with the world around them.

We want to thank you for partnering with us, for entrusting your child to us as they begin their educational journey and for allowing us to speak truth and love into your child’s life. Our promise to all our parents is to educate for wholeness by engaging God’s world in the servant way of Jesus. Our hope is that your child begins to unpack all the gifts that make them completely unique as they become fully alive in God’s story at Surrey Christian School.

We invite you to submit this registration form as soon as possible as space is limited.

Director of Early Learning Programs, Ingrid Fritsch
Principal Tom Williams, Fleetwood Campus | Principal Patti Thomas, Cloverdale Campus
Early Learning Managers: Genny Buchanan, Cloverdale Campus | Jean Chen, Clayton Campus

Today's date * +

STUDENT DETAILS

Child's start date for out of school care. (First day of school is Sept. 6, 2022.) * +

Student legal first name *

Student middle name

Student surname *

Name child responds to (if different than legal first name)

Campus *

Fleetwood Campus

Cloverdale Campus

Grade level in Sept. 2022 *

Child's birthdate * +

Gender *

Male

Female

Registering for *

Before school care

After school care

Before and after school care

Days my child requires care: *

Language spoken at home *

HOUSEHOLD INFORMATION

Household primary phone number *

Household primary email address *

The child will live with *

If a court order has been made concerning the care/custody of the child please attach a copy when you get to the section that allows attachments to be uploaded.

Mother first name

Mother surname

Mother email address (if different than primary email address entered above)

Mother cell phone number

Mother work phone number

Mother occupation

Mother employer

Father first name

Father surname

Father email address

Father cell phone number

Father work phone number

Father occupation

Father employer

Family street address *

Unit/Apartment #

City *

Province *

Postal code *

NAMES OF OTHERS LIVING IN SAME HOUSEHOLD

Name

Relationship to student

Age

Gender

Male

Female

Name

Relationship to student

Age

Gender

Male

Female

Name

Relationship to student

Age

Gender

Male

Female

Use this space to add further household members

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 3 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

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

Relationship to student

Phone number

ADDITIONAL INFORMATION

What are your child's interest? *

Please explain if there is anything else you want us to know about your child? (health concerns, speech, hearing or vision problems etc.)

Are there any special family circumstances the school should know about?

CONSENTS

Field Trip Consent

Acknowledgement of Risk

Students occasionally go on a walk through the neighbourhood. I/We have read the school's Acknowledgement of Risk form and consent to having my child go on supervised walks during the school year. *

Yes

No

Photograph Publishing Consent

Throughout the school year photographs are taken of various student activities. By signing below, I/we consent to have the student’s picture published in the school newsletter, yearbook, publications or on our website. The school only publishes first names of students. *

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 Obligation

I acknowledge my financial obligation to the school. If during the course of the school year I intend to withdraw my child I understand that I must give 1 month’s notice to the school at month-end, or pay 1 month of tuition in lieu of notice. *

Yes

I understand that I will be charged a $75 fee if I request a change to my out-of-school-care arrangements (going from 2 days to 3 days, from AM only to both AM & PM etc.) *

Yes

Protecting Your Personal Information

Surrey Christian School collects and uses personal information for the sole purpose of maintaining accurate student records in the administrative offices, and to respond immediately to an emergency. SCS commits to using and storing this information responsibly and will not release this information to a third party without your verbal or written consent unless permitted under the PIPA (Personal Information Privacy Act) legislation. If you have questions about SCS’s use, storage or disclosure of personal information, please contact our privacy officer. I consent to having SCS collect, use and disclose this personal information as outlined above. *

Yes

FINANCIAL COMMITMENT

Choose applicable monthly fee *

As part of the government opt-in program, kindergarten families will receive a monthly discount. The amount will be determined upon registration.

Fee payment *

I will pay the fees in full on the first day of school

I will pay the fees monthly on the first of the month by pre-authorized payments

Link to Pre-authorized Debit Form

Who will be paying the fees? *

Parent

Government subsidy (note there is always a parent portion that is required to be paid)

Other (please specify name, phone number and email address) Other (please specify name, phone number and email address)

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