Course Registration Form

For more information on ESC programs click here.

Interested in a Trial Class? Need help registering? Email learn@explorescienceclub.com.

If you are experiencing technical issues on a mobile phone, try registering on desktop. If the issue is not resolved please email for assistance!

To add your name to the waitlist click here.
Registration Form

All students are required to fill out a registration form. One form per student. Payments are processed securely through Square. You will receive a confirmation email, which includes a copy of this form.
Student Name*

First NameLast Name
Program *
For one month & single class passes: What date (s) will your child attend?
What school did you require pickup from? (Only for select courses)
If you are joining after the beginning of the month, your second month will be pro-rated.

Open Programs:*

Nature Explorer (age 3-6, Sept to June)$165.00CAD

Sept 24-June 25 Tuesdays 9:30-1:30 Please choose the from options below:

After School Adventure Club (Mondays only, Age 5-12, Sept-June ) 2$165.00CAD

Mondays on school days 3:30-5:30. 2024-5 registration now open. Please choose the from options below:

After School Adventure Club (Tuesdays, Age 5-12, Sept-June ) $185.00CAD

Tuesdays on school days 3:30-5:30. 2024-5 registration open. Please choose the from options below:

After School Adventure Club (Thursdays, Age 5-12, Sept-June ) 2$185.00CAD

Thursdays on school days 3:30-5:30. 2024-5 registration open. Please choose the from options below:

After School Adventure Club (3 days a week Age 5-12, Sept-June ) $450.00CAD

Mondays, Tuesdays, Thursdays on school days school pickup-5:30. Pickup from school included. Please choose from options below:

ProD Fun Day$65.00CAD

Click to choose dates available: Oct 4-0/7, Oct 25- 0/7, Nov 8- 2/7. Add your name to waitlist if full.

Available Dates	Quantity
Oct 4 (Langley)
Oct 25 (Langley & Surrey)
Nov 8 (Langley & Surrey)

Science in Nature CAMPS $300.00CAD

Click to choose weeks available. $300-Ages 5-12. Buckley Park/Brydon Lagoon. Withdrawal notice period as follows: 4 weeks for full refund. 3 week for 50% refund.

CHOOSE WEEK (S)	Quantity
March Break (Mar 18-22)-sold out
Summer 2 (Jul 15 -19)-sold out
Summer 3 (Jul 22-26)- 1 spot

Enter coupon

Total $0.00CAD

Credit Card

Registering for more than 1 day of Adventure Club? Use code AFTERSCHOOL5 to get 5% discount (only when registering for 2+ days not for single days eg. Tu/Th). Your fee will go towards your first month. 50% not refundable in case of withdrawal, if withdrawal on or after July 15 no refund is given. If you require pickup make sure you choose the option with pickup.

For other programs no refund issued after July 31

Your payment is processed securely through Square. If you encounter any problem please email learn@explorescienceclub.com.

Any 3rd party fees are not refunded

If class is full you can add your name to the waitlist, please register here: https://www.jotform.com/build/201086189031248.
Program 2
Birth Date*

MonthDayYear
Gender
Address*

Unit

Street Address

CityState / Province

Postal / Zip CodeCountry
Parent Name*

First NameLast Name
Parent E-mail*
Emergency Cell Number 1*

Area CodePhone Number
Emergency Cell number 2*

Area CodePhone Number
Phone Number

Area CodePhone Number
Work Number

Area CodePhone Number
BC Services/CareCard Number*
Does your child suffer from life threatening allergies?*

YesNo
Does your child take medication we should know about?*

YesNo
If you answered yes to any of the 2 last questions, please provide details below. All information is confidential.
My child's vaccine status is upto date (Fraser Health question)*

YesNoDon't know
Have you paid for your program? Payment due upon registration. Payments should be made here: https://explore-science-club.square.site/*

Yes
ESC programs are a place for learning and play. Their purpose, is to ensure every child enjoys all the sessions, and to provide an environment where children experience the full enrichment value of the experience, while remaining safe. To achieve and support every young person attending, we expect children to adhere to ESC Code of Conduct at every session. Do you agree?*

Yes
Additional Comments
Photo Release:

Please advise us if you are willing to have your child’s image and voice
used for promotional purposes by ESC, as indicated below:

I give permission to ESC staff to photograph and record my child’s image and voice on still photographs as well as
audio and video media and to use this material, in whole or in part, now and in the future, for the promotion of ESC.
Please choose one option*

Full release: I give permission/consent for all uses as specified above. We may post pictures or video including your child on our website, social media, and any other such usesInternal release: give permission/consent for internal uses only. This includes photos and documentation posted/ emailed to class parents or as part of a group photo in another child’s portfolioNo release: I DO NOT give my permission/consent. Wherever possible, your child will not be photographed. Should s/he be included in a group photo, your child will be cropped out of the image
Name of parent/guardian signing this application*
I am authorised to sign this form on behalf of above named child*

YesNo
Would you like to be the first to find out about ESC courses, camps, events and more? Join our newsletter

Yes
Where did you hear about this program

NewsletterFriendFacebookCommunity EventGooglePosterOther
If other please specify
Did someone refer you to this program? If yes, please provide their full name and valid email address so ESC can thank them
If you have any questions please email: learn@explorescienceclub.com
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