School Year 2025/26 Registration

2025/26 School Year Outdoor Learning Program Registration Form

Room to Roam Outdoor Learning Inc.
Program Information
Expected Start Date

MonthDayYear
Bluebells Program
from September to June
children aged 2.5 – 5 years
2 days – Monday and Wednesday - ($340 per month) **FULL**
2 days – Tuesday and Thursday - ($340 per month)
4 days – Mon, Tue, Wed, Thurs - ($620 per month) **FULL**
* Add Friday mornings for an additional $160 per month

Friday AM Program (one day only option)
from September to June
children aged 2.5 – 5 years
Friday mornings from 9 am – 12 pm
$180 per month
Please select the Program you would like to register for below:
Would you like to add Fridays to the Bluebells Program for an additional $160/month?
NOTE:

If the option(s) you wish to register for is not visible, it is at full capacity.
Child's Information
Child's Name (Participant)

First NameLast Name
Child's Preferred Name
Please upload a headshot photo of your child.
Gender
Child Date of Birth

MonthDayYear
Parent/Guardian Information 1
Full Name

First NameLast Name
Cell
Format: (000) 000-0000.
Home
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail

Confirmation Emailexample@example.com
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information 2
Full Name

First NameLast Name
Cell
Format: (000) 000-0000.
Home
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail

Confirmation Emailexample@example.com
If your address is different than the above Parent/Guardian 1 address please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there a custody agreement?
Please provide details below.
Emergency Contact - Other than Parents/Guardians

Please specify at least one contact below.
Contact #1 Full Name

First NameLast Name
Relationship to child
Cell
Format: (000) 000-0000.
Home or Work
Format: (000) 000-0000.
Contact #2 Full Name

First NameLast Name
Relationship to child
Home or Work
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Child Release - Other than Parents/Guardians

Please list the names of people who are authorized to drop-off and pickup your child (other than Parents/Guardians previously mentioned).
Authorized Person #1

First NameLast Name
Relationship to child
Cell
Format: (000) 000-0000.
Authorized Person #2

First NameLast Name
Relationship to child
Cell
Format: (000) 000-0000.
Medical Information
Does your child have a BC Medical Services Plan (MSP) Number?
Please provide your child's BC Medical Services Plan (MSP) Number
Please provide additional information if your child does not have an MSP number.
Is your child immunized?
Does your child have any allergies?
Please list them below, including any food or drug allergies.
Does your child have a special diet for health or religious reasons? If so, please provide restrictions.
Does your child have any medical conditions?
Does your child have any speech or language problems?
Does your child have any vision problems?
Does your child require any medication? If yes, please list these medications.
Please indicate any prior accident(s), illness(es) or medical procedures Room to Roam should be aware of.
Child Questionnaire

The following questions are meant to help us learn more about your child, so we can provide a smooth transition into our programs.
Has your Child previously attended daycare, preschool or other group care? If so, list facility. Were there any problems?
Has your child ever been stung by a bee or wasp?
Does your child have a fear of dogs?
Does your child have any special interest in or concerns about the outdoors?
Describe your child’s comfort level around animals.
Does your child have any experience toileting outdoors? Special words used by child for toileting?
What is your child’s energy level? (1 for low and 10 for very high)
Does your child tend to wander?
Does your child respond their name and to basic instructions like “stop”?
Describe your family’s connection to the natural world.
What language(s) does your child speak at home?
Is there any other information that you feel we should be aware of for your child to have a smooth transition into our program?
Photo Consent

At Room to Roam we frequently take photographs or videos of participants in our programs. With your permission, these photographs and videos help us design and produce web and social media updates and other marketing pieces that help us communicate “what children do” at Room to Roam. No names will appear with the photos.
I grant my permission for Room to Roam to use photographs or video taken of my child by Room to Roam representatives, staff, volunteers or any person acting on their behalf, for publication, posting on the Room to Roam website, advertising, social media, display, or copyright purposes. Furthermore, I agree that no royalties, fees or other compensation shall become payable to me by reason of such use. I hereby release Room to Roam, their representatives, employees or any person acting on their behalf, from any and all claims of any kind which I might otherwise have, now or in the future, in connection with the use, in whole or in part. I understand that I may revoke my authorization by notifying Room to Roam in writing. The revocation will not affect any actions taken before the written notification.
General Terms and Conditions
EPI-PENS We are often in locations where we are unable to access medical assistance in a timely manner. If a child comes into contact with something that causes a severe allergic reaction and that child is unable to breathe we will use an Epi-Pen on your child. Our staff are trained in First Aid, which includes the ability to assess and identify a severe allergic reaction that may require the use of an Epi-Pen to treat the symptoms. In the event of a severe allergic reaction, do we have permission to use an Epi-Pen on your child?
HEALTH CHECK The Parents/Guardians acknowledges and agrees to check the Child's health prior to attending the program each day. If the Child exhibits any of the following symptoms or conditions, the Parents/Guardians must not send their Child: Fever, Nausea or Vomiting. For the following conditions, a child can return to the program after being symptom-free for at least 24 hours: Skin rash or evidence of chicken pox, measles, mumps, rubella, or other communicable disease; Evidence of respiratory infection accompanied by fever, sore throat, runny nose, earache and/cough; Severe itching of body or scalp; Unexplained or undiagnosed pain; Conjunctivitis, commonly referred to as pink eye; Diarrhea; COVID-19. Evidence of COVID-19 which may include fever, chills, cough, loss of sense of smell or taste, difficulty breathing, sore throat, loss of appetite, extreme fatigue or tiredness, headache, body aches, nausea or vomiting, and diarrhea.
HYGIENE Room to Roam understands that proper hygiene is essential to keep children healthy and safe. Room to Roam provides warm water and soap for handwashing before eating and after going to the bathroom. Hand sanitizer will be provided if water/soap is not available. We ask Parents to provide a hand towel for hand drying.
ROAMING PROGRAM As Room to Roam is a “roaming” program in that we rotate among different parks throughout the year, the Parent/Guardian acknowledges and agrees that Room to Roam does at times venture outside of the designated parks, into accessible trails and into nearby neighborhoods with children. We do so mostly by walking, but we may also at times take children on local transit to explore other neighborhoods. Room to Roam will communicate with Parents/Guardians in advance to taking children on transit.
SIGN IN / OUT POLICY The safety of children is a primary concern to Room to Roam. Pick up and drop off times can be busy and we may not see your child leave. We must ensure your child leaves with their Parents/Guardians or authorized pick-up person. We ask Parents/Guardians or authorized persons to please sign out your child at the end of the day. Your child will only be released to an authorized person listed in the Child Release section above and to Parents/Guardians. Under special circumstances, Parents/Guardians can request an authorization for persons not listed in the Child Release section to pick up their Child. This request must be provided both verbally and in written form (text or email) and state the person’s full name. Persons picking up your child must bring a valid photo identification. Any person unfamiliar to the Educator will be required to show identification. Your Child will only be released to Parents/Guardians or authorized persons.
EMERGENCY CONSENT Room to Roam will notify Parents/Guardians when a child is ill or needs medical attention. If we cannot reach the Parents/Gardians we will contact any Emergency Contacts in the order they were provided. If Room to Roam is unable to contact anyone and your child needs immediate help, we will take your child to the nearest emergency centre or call an ambulance so your child can be taken to the nearest emergency centre. You agree that we may take your child to the nearest emergency centre when you cannot be contacted and you consent to allow your child to receive medical treatment as required.
CONFIDENTIALITY POLICY It is the policy of Room to Roam that any information or records held regarding your family and child(ren) will be kept confidential. The only release of information or records would be for a legal matter that is requested or required by law. It is also appreciated that any information you become aware of regarding other families at Room to Roam be kept confidential.
PAYMENT POLICY A deposit equivalent to one month’s fees is required at the time of registration. The deposit is held interest free and will be put towards the fees for the month of June or your child’s last month of attendance. A non-refundable registration fee of $50 is required at the time of registration. Room to Roam will invoice the Parents/Guardians on a monthly basis or require monthly pre-authorized payments at its discretion. Monthly fees are due on the 1st of each month. Parents/Guardians will not be reimbursed for any missed days of the program due to child sickness or unforeseen circumstances outside Room to Roam’s control (such as weather conditions or anything that would make it unsafe to run the program). Room to Roam strives to operate in all-weather but there are times when we must cancel due to extreme conditions. Room to Roam is unable to offer make-up days for missed classes.
WITHDRAWAL POLICY Prior to the child beginning the program, the deposit is non-refundable. Once the program has commenced, in the event Parents/Guardians wish to withdraw the Child from the program, the Parents/Guardians must provide Room to Roam with 30 days written notice of withdrawal. If proper notice is not given, the Deposit will be forfeited (i.e. If the last day of care will be January 31st, notice must be given by January 1st). During temporary absences (such as family vacations), Parents/Guardians must keep current with fees at all times to retain their Child's spot. For extended absences from the program, Parents/Guardians must either pay the appropriate monthly fees to hold their child’s spot or withdraw from the program. The Parents/Guardians may re-register their child upon their return if there is space in the program.
Please tell us how you head about Room to Roam Outdoor Learning.
RELEASE OF LIABILTY, WAIVER OF CLAIMS and ASSUMPTION OF RISKS & INDEMNITY AGREEMENT

PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION.
1. This agreement is being entered into by and between {child_name} ("Participant") and Room to Roam Outdoor Leaning Inc. ("Room to Roam" or "Company"), collectively known as the “Parties”. I, the undersigned, am a Participant or, if the Participant is under the age of 19, I am the Participant’s parent or legal guardian. I understand that participating in the outdoor learning program, including hiking, running, climbing, digging, fishing, gardening, using tools, being in and in proximity to bodies of water, including lakes, streams, rivers, ponds, and the ocean, fire, and interacting with vegetation, natural landscape features, animals, and livestock for any purpose and use of forest, trails, parking lots, roads and crossways (collectively, the “Activity”) can be hazardous and involve the risk of physical injury and/or death.
2. I understand that dangers and risks of the Activity and that the Participant assumes all inherent dangers and risks of the Activity.
3. I expressly acknowledge and assume all additional risks and dangers that may result in property damage, physical injury and/or death, which may be above and beyond the inherent dangers and risks of the Activity, including but not limited to: transmission of infectious diseases and illness or death resulting from these diseases, accidents, illness or problems that occur in areas without immediate access to medical facilities, forces of nature including lightning, storms, wind, rain, snow, ice, cold, heat, weather changes, and changes in water level, any injuries including wounds and injuries to skin, organs, muscles, joints and bones inflicted by tools, animals, plants, sunshine, water, ice, fire or other natural forces, physical exertion that can cause fatigue, soreness, joint stiffness and blisters: any damages or injury caused as a result of any physical defect in any manufacturer’s products or arising from the improper use of products; any interaction with wildlife or other animals; interactions with other children and adults in an outdoor environment; or the negligence or failure of the Participant, Room to Roam employees, volunteers, or other guest to act safely. I understand that the description of the risks in this agreement are not complete and voluntarily choose for the Participant to participate in and expressly assume all risks and dangers of the Activity and the possibility of personal injury, death, property damage and loss resulting therefrom, whether or not described here, known or unknown, inherent or otherwise.
4. Participant assumes responsibility for reading, understanding and complying with Room to Roam Policies and Procedures Manual and understands the policies that Room to Roam has in place for site and activity assessment and mitigation.
5. In consideration for allowing the Participant to participate in the Activity, I agree, to the greatest extend permitted by law, to waive any and all claims against and to hold harmless, release, indemnify, and agree not to sue Room to Roam and all their respective insurance companies, successors in interest, affiliates, agents, employees, volunteer representatives, assignees, officers, directors and shareholders, the City of Port Coquitlam, the City of Coquitlam (each a “Released Party”) for any injury, including death, loss, property damage or expense, which I or the Participant may suffer, arising in whole or in part out of the Participant’s participation in the Activity, including, but not limited to, those claims based on any Released Party’s alleged or actual negligence or breach of any contract and/or express or implied warranty or breach of any statutory or other duty of care and any duty of care under the Occupiers Liability Act. I understand that negligence includes failure on the part of any Released Party to take reasonable steps to safeguard or protect against the risks, dangers and hazards of the Activity. In further consideration for allowing the Participant to participate in the Activity, I further release and give up any and all claims and rights that I may now have against any Released Party and understand this releases all claims, including those of which I am not aware. Those not mentioned in this release and those resulting from anything which has happened up to now.
6. I also agree to pay all costs, including legal fees, incurred by any Released Party in defending and investigation, claim or lawsuit brought by or on the Participant’s behalf whether arising in whole or in part from the Participant’s participation in any Activity or from any misrepresentations or fraudulent execution of the Agreement.
7. I agree that any and all claims for loss, injury and /or death arising from the Participant’s participation in the Activity shall be governed by the laws of the Province of British Columbia and that exclusive jurisdiction of any such claim shall be in a court of competent jurisdiction in the Province of British Columbia.
8. By signing on behalf of a minor or other Participant, I represent that I am authorized to sign on the Participant’s behalf and/or I am the parent or legal guardian of the minor Participant and acknowledge that the Participant is bound by all the terms of this Agreement. I understand that the minor Participant would not be permitted to take part in any of the Activity unless I agree to the terms of this Agreement. By signing this Agreement without a parent or legal guardian’s signature, I represent, I am at least 19 years old.
9. I understand that this Agreement will apply for each and every day the Participant participates in any Activity. I understand that this Agreement is a contract and, to the fullest extent permitted by law, shall be binding on me and my assignees, heirs, next of kin, executors and personal representatives. If any part of this Agreement is deemed to be unenforceable, the remaining terms shall be an enforceable contract between the Parties.
Click below if you agree with the above RELEASE OF LIABILTY, WAIVER OF CLAIMS and ASSUMPTION OF RISKS & INDEMNITY AGREEMENT
CONFIRMATION OF REGISTRATION:

Once your registration has been approved you will receive an invoice for the following:
1. One-time Registration Fee - $50 (not applicable for Drop-ins)
2. Deposit equal to 1-month's fees for the selected program (not applicable for Drop-ins). The Deposit is held and used for your child's last month of attendance in the selected program.
3. The monthly fee will be due on the 1st of each month. If you are registering during the school year and your child is starting immediately then your fees are due upon registration.
Payment must be received within 1 day of the invoice date to complete the registration and secure your spot. If payment is not received your registration may be cancelled.

All registrations are received and reviewed on a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Provide any comments or questions if applicable.
Signature
Should be Empty:

2025/26 School Year Outdoor Learning Program Registration Form

Program Information

Child's Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parents/Guardians

Child Release - Other than Parents/Guardians

Medical Information

Child Questionnaire

Photo Consent

General Terms and Conditions

RELEASE OF LIABILTY, WAIVER OF CLAIMS and ASSUMPTION OF RISKS & INDEMNITY AGREEMENT