Wildwood Educational Enrichment Centre


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

Workshop Application


Child’s name__________________________________________________________age_____Birthday______________

Child’s name__________________________________________________________age_____Birthday______________

Address________________________City___________________Postal Code________

I am paying with funds from: DL:_________________My own funds:_____________ Has payment been made?
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!


NAME__________________________________________RELATIONSHIP TO CHILD_________________________


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.


Wildwood Educational Enrichment Centre


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.


Please circle: Parent / Legal Guardian

Child’s Physician: __________________________________________phone number: ________________________

Physician’s address: __________________________________________________________________________


In case of emergency please call:

NAME___________________________________________RELATIONSHIP TO CHILD________________________

PHONE____________________________________CELL PHONE______________________________________


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.