Wildwood Educational Enrichment Centre

CREATIVITY * INSPIRATION * COMMUNITY

Box 438, Fort Langley, B.C. V1M 2R7

Workshop Application


Workshop___________________________________________________________Date__________________


Child’s name__________________________________________________________age___________________


Child’s name__________________________________________________________age___________________


Address________________________City___________________Postal Code________


I am paying with funds from: DL:_________________My own funds:_____________
NOTE: Your post-dated cheque will be returned to you when your DL funds come through. If the DL funds do not come through within 3 weeks of the start of the course, your cheque will be cashed. Please let your DL know well before the start of the course!


PARENT/GUARDIAN INFORMATION


NAME__________________________________________RELATIONSHIP TO CHILD_________________________


ADDRESS_________________________________________________________________________________


CITY__________________________________________________POSTAL CODE_________________________


HOME PHONE___________________WORK PHONE____________________CELL PHONE______________________


EMAIL ADDRESS_____________________________________________________________________________


Is there anything that I should know about your child(ren)?  In order to give your child the best Wildwood experience possible, it is important for me to know about any challenges your child faces, whether they are allergies or behaviours. 


 ________________________________________________________________________________________


_________________________________________________________________________________________


Payment and Refund Policy

To hold a spot in a Wildwood course or camp, we require a post-dated cheque, dated for four weeks before the first day of the course. If these are not received, the spot cannot be held. If the course is cancelled, your deposit and cheque will be returned. 

If you drop out of the course before four weeks prior to the first class, your cheque will be returned, less a $25 cancellation fee. Post-dated cheques are cashed four weeks before a course begins, after that there is no refund. If you drop out during the course, or if your child is asked to leave due to behavioral problems, there is no refund.




MEDICAL INFORMATION

Wildwood Educational Enrichment Centre


HEALTH CARE INFORMATION

I, ________________________________________________________________, am the parent or guardian having


legal custody of______________________________________________________________. I authorize all medical,


surgical, diagnostic and hospital care or procedures which may be performed or prescribed for my child by a licensed physician or

hospital, when efforts to contact me are unsuccessful and when deemed immediately necessary or advisable by the physician 


to safeguard my child’s health. I waive my right of informed consent to such treatment.


Signature:___________________________________________________date:___________________________


Please designate: Parent / Legal Guardian


Child’s Physician: __________________________________________phone number: ________________________


Physician’s address: __________________________________________________________________________


EMERGENCY CONTACT INFORMATION:

In case of emergency please call:


NAME___________________________________________RELATIONSHIP TO CHILD________________________


PHONE____________________________________CELL PHONE______________________________________


WELCOME TO WILDWOOD!

Wildwood welcomes cultural, racial, and ethnic diversity

and families of every composition. We do not discriminate on the basis of race,

colour, sexual orientation, gender, or national or ethnic origins.