Preschool Registration 2025

Preschool Registration 2025 - 2026

Please fill in all fields
IMPORTANT NOTICE: PRESCHOOL REGISTRATION REQUIREMENTS

To complete the preschool registration form, please ensure you provide the following:

A void cheque
Custody agreement forms (if applicable)
Your child’s Personal Health Number
An emergency contact
An out-of-town emergency contact
Your child’s immunization information

Fee Disclaimer:

The annual field trip and event fee of $250.00 per child is refundable up to 60 days before September 1, 2025. This fee is optional, however if you choose not to pay, your child will not be able to participate in these extra activities. Doing these outings is one of the exciting opportunities that we can offer your child and is apart of our preschool program.
Please answer the question:

Yes, I agree to pay the fee of $250.00.No, I will not be paying the fee of $250.00.

Registration Disclaimer:

We will do their best to accommodate all students and families, but please note that your application does not guarantee you a spot in Young Climbers Preschool Program.
4 YEAR OLD PROGRAM (Must be 4 years of age by December 31,2025)
Monday, Wednesday, Friday 9:00 - 11:30 AM
$ 250.00 Yearly Parent Fee
$ 84.00 per month (June 2026 payment)
$ 334.00 Due at Registration

3/4 YEAR OLD PROGRAM
Monday, Wednesday 12:30 – 3:00 PM
$ 250.00 Yearly Parent Fee
$ 56.00 per month (June 2026 payment)
$ 306.00 Due at Registration

3/4 YEAR OLD PROGRAM
Tuesday, Thursday 9:00 - 11:30 AM
$ 250.00 Yearly Parent Fee
$ 56.00 per month (June 2025 payment)
$ 306.00 Due at Registration

3/4 YEAR OLD PROGRAM
Tuesday, Thursday 12:30 – 3:00 PM
$ 250.00 Yearly Parent Fee
$ 56.00 per month (June 2026 payment)
$ 306.00 Due at Registration
Please choose which class you would like to enroll your child in:

Child's Information
Child's Information

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Health Number

Parent's Information
Parent / Guardian : 1

First NameLast Name
Parent / Guardian Relationship: 1

MotherFatherGuardianOther
Parent / Guardian: 1 Relationship Status

SingleMarriedDivorcedSeperated
Parent / Guardian: 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian: 1 Email
example@example.com
Parent / Guardian: 1 Phone Number

Out of Town Emergency Contact

Outside the Lower mainland
Out of Town Contact Name

First NameLast Name
Out of Town Phone Number
Relationship to Child
ex. Grandparent / Uncle / Friend/ Neighbours
Where are they located?
What city are they located?

Emergency Contact

Someone other than parents
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Relationship to Child
ex. Grandparent / Uncle/ Friend / Neighbour
Where is this person located?
What city are they located?

Custody
If there is any custody agreement in effect, please give details as they relate to the child and attach a copy to this form.
Custody Agreement

Cancelof

Other persons living in the home
Name: blanks Age: blank
Sibiling Grandparent Other
Name: blanks Age: blank
Sibiling Grandparent Other

Authorized Pick Up Information

Someone other than parents
1. Authorized Pick Up Contact Name

First NameLast Name
1. Authorized Pick Up Phone Number
1. Relationship to Child
ex. Grandparent / Uncle/ Friend / Neighbour
2. Authorized Pick Up Contact Name

First NameLast Name
2. Authorized Pick Up Phone Number
2. Relationship to Child
ex. Grandparent / Uncle/ Friend / Neighbour

Language Skills and Family Origin
What Language does your child speak at home?
Ex. English
Does your child speak a second language?
Where does your family originate from?
Does your child understand/speak English?

Health Providers Information: Doctor
Do you have a Family Doctor?
Family Doctors Name / Name of Clinic:
Family Doctors Phone Number / Phone number of Clinic:

Health Providers Information: Dentist
Do you have a Dentist?
Dentist Name:

First NameLast Name
Dentist Phone Number:

Child's Immunizations
Are your child's immunizations up to date?

YesNo
The medical certificate of vaccinations can be located:
Ex. Home, Doctors Office, Clinic
I have chosen not to immunize my child.

YesNo
I,blanksunderstand that if an outbreak occurs, it is the parent's responsibility to
keep their child home from the Centre until it has been determined that the child's health is
no longer at risk and the communicable disease or infection is no longer.

Allergies

Food, Animals, Seasonal
Does your child have any allergies?

YesNo
Do they require an Epi-pen?

YesNo
Please list below:
If your child is allergic to peanuts or nuts, is it OK for your child to eat products that are made in a facility that may contain nuts or traces of tree nuts?

Food restrictions
Does your child have any food/ religious restrictions?

YesNo
Please list below:

Child's Temperment
How does your child interact with their friends?
What kinds of things does your child like to do at home?
How do they listen/respond to others?
When your child gets frustrated how do they react?

Lillio Participation and Photo Release Form
Dear parent/legal guardian,

In the interest of safety and security, we require parental permission for the
publishing of photographs and videos of your child/children through a software
program called Lillio (formerly HiMama) (the “Program”).
By signing this form, you grant permission for us to photograph or video your childand share this information with you through the Program. You will also receive updates and information about your child through the Program through the emailyou provided.

Please note: Other children may be featured in photos, videos, or stories of yourchild. By giving your consent, you agree not to share pictures or videos of any child- other than your own - outside the Program without permission. To learn moreabout the Program, please visit www.lillio.com.

Please complete, sign, and return this form to the center if you wish to participate.

Please contact us if you have any questions.
Do you agree to these terms?

YesNo

Parent Contract
Thank you for registering your child, {childsInformation} at Young Climbers Childcare Centre.

This contract is a binding contract between Young Climbers Childcare Centre and the Parent.

The next steps require us to have your personal bank account information.
Please attach your Void Cheque to the bottom of the page.

I understand that the fee of:

2 Days a week: $56.00 Per Month
3 Days a week: $84.00 Per Month

These fees are due on the 1st of every month. If the payment is not made by the 1st of each month, the child cannot attend the childcare facility until the payment is made in full.

Registration fees and a void cheque will be required at the time of preschool registration. In addition, 45 days written notice is required to remove my child, from Young Climbers Childcare Centre for any reason. If this notice is not given, a fee of one month in lieu of notice will be required.

I understand that there will be a $50.00 service charge applied from Young Climbers Childcare Centre for any returned payment from your financial institution.

PRE-AUTHORIZED DEBIT FORM
I have enrolled my child, {childsInformation} at Young Climbers
Childcare Centre, and I desire to pay the monthly fee through this pre-authorized debit agreement.

Please debit my account which corresponds to the attached VOID cheque.

I agree that will be taken from my account on the 1st of each month or the next business day from the time I start at Young Climbers.

Young Climbers Childcare Centre

7328 144st,
Surrey, BC
V3W 5S5
Transit Number
For Office Use Only
Financial Institution Number Number
For Office Use Only
Bank Account Number Number
For Office Use Only
Account Holder Name

First NameLast Name
Account Holder Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Void Cheque Upload

Cancelof

Young Climbers Illness Policy Consent Form
We care about the health of our students and staff. When our staff are sick they are required by law to assess if they can work, and we must test accordingly. As a government-subsidized facility, if too many of our staff are sick we will have to close our facility until proper ratios can be met. Please review our policies on illness and symptoms at our centre.

Your Child cannot attend or will be SENT HOME AND UNABLE TO ATTEND SCHOOL for the following conditions:

• Fever over 38.3 (101F)

• Infected eyes or skin (Pink Eye, Contagious Rash)

• Any type of contagious disease such as the Flu, Measles, Mumps, Rubella, Chickenpox and Head lice (please wash and remove nits from the head and once the head is clear you may return to school)

• Unexplained Diarrhea or Loose Stool with Nausea, Vomiting or Abdominal pain

• Cold, with symptoms such as Fever, Sore throat, Earache, Runny nose (Green and Yellow Mucus), and Cough, Congestion to the point that he/she has heavy breathing

**If a child becomes sick at daycare, the parent will be called and if unable to reach or unavailable to pick up, the guardian or authorized person will be called and asked to get the child. The staff will isolate the child from the other children and make the child as comfortable as possible but will not administer medication unless previously authorized to do so.

***Please keep your child at home for at least 24 hours after your child's last symptom. Please stay home until the child is well enough to join class again
Do you agree to these terms

YesNo
Signature

Clear

Consent Forms
Field Trip Consent:
I hereby give my consent to the Staff to take my child, for walk or trips away from Young Climbers Childcare Centre.

Visitor Consent:
I give my consent to allow supervised Practicum Students and other authorized adults that are approved by the Young Climbers Childcare Centre to be apart of the daily classroom and take pictures of my child, for educational purposes.

Medical Consent:
I hereby give my consent to the staff at Young Climbers Childcare Centre to call 911 to help my child, in case of emergency and, if needed, transport them to the nearest hospital. (Surrey Memorial)

Medication Consent:
If required and with doctor’s note on file with the Childcare Centre, I allow my child, to be administered medication by a staff member of Young Climbers Childcare Centre.

Consent to Photograph:
I hereby give my consent to the staff at Young Climbers Childcare Centre to take and/or have photographs of my child .I understand the photographs may be used by Young Climbers Childcare Center in its program, meetings, newspaper, magazines, computer web pages, Facebook, or other such publications.

Food Consent:
I will provide healthy snacks, water bottle for my child each day that they attend the Young Climbers Childcare Centre.
Please answer:

Yes I agree to all the terms aboveNo, I do not agree with all the terms above
Signature

Clear

Young Climbers Childcare Centre

Emergency Consent Card
Child's Information: {childsInformation} Gender:{gender}

Birthdate: {dateOf} Address: {childsAddress}

Parent/Guardian 1: {parent} Parent/ Guardian #: {phoneNumber37}

Parent/Guardian 2: {parent28} Parent/Guardian #: {parent36}

Emergency Contact: {emergencyContact57} Phone Number: {emergencyContact58}

Out of Town Contact: {name59} Out of Town Phone Number: {outOf60}

Vaccinations: {typeA145}

Allergies and Medications: {pleaseList127} {pleaseList132}

Child's Doctor: {familyDoctors} Child's Doctors Phone Number: {familyDoctors94}

Child's Dentist: {dentistName} Child's Dentist Phone Number: {dentistPhone}

Personal Health Number: {personalHealth}
I hereby give consent for my child First Name Last Name to be taken to the nearest emergency centre when I cannot be contacted. YES NO
I hereby give consent for my child named above to receive medical treatment. YES NO
Signature

Clear
Should be Empty:

Preschool Registration 2025 - 2026

Registration Disclaimer:

Child's Information

Parent's Information

Parent's Information

Out of Town Emergency Contact

Emergency Contact

Custody

Other persons living in the home

Authorized Pick Up Information

Language Skills and Family Origin

Health Providers Information: Doctor

Health Providers Information: Dentist

Child's Health Inquiry

Child's Immunizations

Allergies

Food restrictions

Child's Temperment

Lillio Participation and Photo Release Form

Parent Contract

PRE-AUTHORIZED DEBIT FORM

Young Climbers Illness Policy Consent Form

Consent Forms

Young Climbers Childcare Centre