Course Registration Form

For information on any of these programs

visit

www.explorescienceclub.com

Want to join us for a Sampler class? Email learn@explorescienceclub.com
Registration Form

All students are required to fill out a registration form. 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 *
Single Class Pass Date (What date 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 Explorers Deposit (3-5, Sep 23 - Jun 24)$150.00CAD

MWF 9:30-1. Monthly fee $335--$150 due at the time of registration; 5/7 (2023-4). One month notice for withdrawal ( refund except non refundable $50 admin fee).

Nature Explorer-Single Days (3-5; Sept 23-June 24)$145.00CAD

M 9:30-1. Monthly fee: $145; 1/7 available each day. First month due with registration. One month notice for withdrawal. Sept 2023 to June 2024.

Choose Day

After School Adventure Club- Present-June 23$125.00CAD

Mondays 3:30-5:30. Alternate drop off Buckley and Penzer Parks. Pickup ESC Facility. $125/month, runs school days , Present to June 2023. First month due with registration. One month notice for withdrawal. 1/7 spots available.

Transportation to Adventure Club- Present- June 23$35.00CAD

2:00-3:30pm, $35/month, runs school days; Present- June 2023- pickup available only from Belmont Elementary for this session. Starts the Monday after Labour Day. First month due with registration. One month notice for withdrawal. 1/4backseats, 0 front seats available. Booster seats are provided, you are welcome to send your own.

After School Adventure Club- Sept 23-June 24$130.00CAD

Mondays 3:30-5:30. Alternate drop off Buckley and Penzer Parks. Pickup ESC Facility. $130/month, runs school days , Sept 2023-4 starts the Monday after Labour Day. First month deposit due with registration. One month notice for withdrawal. 2/7 spots available.

Transportation to Adventure Club- Sept 23- June 24$35.00CAD

2:00-3:30pm, $35/month, runs school days; Sept 2022-3 starts the Monday after Labour Day. First month due with registration. One month notice for withdrawal. 2/4backseats, 1 front seats available. Booster seats are provided, you are welcome to send your own. Please enquire to confirm we can add your child's school to our route! (vehicle pre-sanitized, children are never left alone in the car)

Kids Food & Garden Club (7-12)$130.00CAD

Age 7-12. Monthly fee $130. ESC Facility. One month notice for withdrawal. First month due with registration. 3/7 spots available.

Transportation to Food & Garden Club Club- Sept 23- June 25$40.00CAD

2:00-4:00pm, $40/month, runs school days; Sept 2022-3 starts the Friday after Labour Day. First month due with registration. One month notice for withdrawal. 2/4backseats, 0 front seats available. Booster seats are provided. Please enquire to confirm we can add your child's school to our route! (vehicle pre-sanitized, children are never left alone in the car)

Science in Nature CAMP (Jul 17-21)$245.00CAD

Ages 5-12. Buckley Park/Brydon Lagoon. Withdrawal notice period as follows: 3 weeks for full refund. 2 week for 50% refund. 0/7 Spots available.

Science in Nature CAMP (Mar 13-17)$245.00CAD

Ages 5-12. Buckley Park/Brydon Lagoon. Withdrawal notice period as follows: 3 weeks for full refund. 2 week for 50% refund. 0/7 Spots available.

Science in Nature CAMP (Jul 10-14)$245.00CAD

Ages 5-12. Buckley Park/Brydon Lagoon. Withdrawal notice period as follows: 3 weeks for full refund. 2 week for 50% refund. 0/7 Spots available.

Science in Nature CAMP (Jul 24-28)$245.00CAD

Ages 5-12. Buckley Park/Brydon Lagoon. Withdrawal notice period as follows: 3 weeks for full refund. 2 week for 50% refund. 0/7 Spots available. Please add your name to the waitlist.

Enter coupon

Total $0.00CAD

Credit Card

Enrolling siblings? Get 5% off your total using SIBLING5 discount code. To enroll siblings fill out one registration form for each child and use this code each time
Program 2
Your payment is processed securely through Square. If you encounter any problem please email learn@explorescienceclub.com.

If class is full you can add your name to the waitlist, please register here: https://www.jotform.com/build/201086189031248.
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
Additional Comments
Photo Release:

Please read the following paragraph carefully.
In the course of learning activities undertaken while attending ESC programs, workshops etc, representatives of ESC,
staff may take photographs or otherwise record events. These photographs and recordings are used to inform
parents of their child’s participation in the program as well as promotional materials such as Facebook posts and
brochures that inform others of the program. 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. I,
on my own behalf and/or on behalf of my child/ward assign and transfer to ESC staff any and all proprietary rights,
including copyright, and waive all personal rights, which I may have or my child/ward may have in this material.
Please choose one option*

Full release: I give permission/consentfor all uses as specified above. We may post pictures or video including your child on our website, on Facebook, and any other such uses covered by the Consent statement aboveInternal release: give permission/consent for internal uses only, including the yearbook and children’s portfolios.This includes photos and documentation posted emailed to class parents and for my child’s picture to become part of his/her own portfolio of learning, or as part of a group photo in another child’s portfolioNo release: I DO NOT give my permission/consentWherever possible, your child will not be photographed. Should he/she be included in a group photo, your child will be cropped out of the image if it is used for internal or external promotion.
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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Registration Form

Credit Card

Photo Release: