Health Information, Permission & Policy Acknowledgement

This form is our way of getting to know your child and includes all the essential information and policies we need to provide exceptional care during their nature adventures. It covers health details, permissions, and important safety policies that every parent and guardian should be aware of.

We encourage you to complete this form with care and detail – your insights about your child help us create personalized experiences that work best for them. The information you provide allows us to build a nurturing, secure environment where your child can discover the joy of outdoor exploration.

Important Note for Shared Custody Families: For children with multiple guardians or households involved in care decisions, we kindly request that each household complete and sign this form. This ensures all caregivers are fully informed and aligned regarding their child's participation in our programs.

We're grateful you've chosen us to be part of your child's journey. Our team is committed to supporting your family every step of the way!

PARENT/GUARDIAN ACKNOWLEDGMENT

This Health Information, Permission and Policy Acknowledgment Form applies to: Child's Full Name:

Completed by:

Relationship to Child:

Date

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EXPLORATION TRIP AUTHORIZATION

I give the Nature and Community Exploration Club Inc and its representatives permission to take my child on short exploration trips and other outings as part of their time in program. This includes transportation by bus, vehicle, on foot or public transportation. Note: Proper drivers licensing and insurance is kept in good standing and the use of approved booster/child restraint seat will be used whenever applicable. If you require a special safety seat please provide one that will be kept on site for the duration of their time in our program. As we are a mobile program, we strive to be as communicative as possible about the daily destination plans, location changes and times. It is extremely helpful if you also communicate your intended pick-up time and location, particularly if it varies day to day.

EVENT WAIVER

In all programs offered by Nature & Community Exploration Club Inc, reasonable care is taken to prevent serious injuries and to minimize accidents. I am aware that all activities, even under the safest of conditions, have inherent dangers. I hereby accept responsibility for, and assume the risk of, injury or damage to my child that might arise as a result of participation in Nature & Community Exploration Club. I hereby release, discharge, and hold faultless from any liability whatsoever, Nature & Community Exploration Club, as well as all employees and/or volunteers in their capacity as representatives of said organization. In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization, or other treatment, as necessary. I agree to hold Nature & Community Exploration Club faultless if full disclosure or a pre- existing condition has not been provided.

HEALTH INFORMATION

Personal Health Number (PHN):

Allergies

Medications

Any behavioral challenges that may require extra support? The more we know about your child's unique needs, the better we can support them in having a positive experience. Please be as honest as possible – there's no judgment here, only our commitment to helping your child thrive.

MEDICAL CONSENT

It is the policy of Nature & Community Exploration Club to notify a parent when a child is ill or needs medical attention. In the event we cannot contact you and your child needs immediate help, we require consent to do so. Select both options to sign, if you agree.

I give consent for my child to be taken to the nearest emergency medical centre when I cannot be contacted.

I give consent for my child to receive medical treatment.

GENERAL RELEASE OF LIABILITY

I affirm that the confidential health and medical information that has been provided is accurate and complete. I understand that failure to disclose all information could affect my child’s wellbeing and safety, and I agree to hold the Nature and Community Exploration Club Inc. and its representatives faultless if full disclosure or a pre-existing condition has not been provided. In the event of illness, medical emergency or injury, consent is hereby given to provide emergency first aid, hospitalization or other treatment as deemed necessary. I understand that at all times diligence will be taken to prevent serious injuries and to minimize accidents. However, I am aware that all activities, even under the safest conditions can have inherent dangers. I hereby accept responsibility for, and assume the risk of, injury or damage to my child(ren) and their belongings, that may arise as a result of participation of indoor and outdoor play. I hereby release, discharge and hold faultless from any liability whatsoever, Nature and Community Exploration Club Inc, as well as all employees and volunteers in their capacity as a representative of said organization.

PHOTO & VIDEO PERMISSIONS

I understand that Nature and Community Exploration Club will take photos and videos of my child during program activities for documentation and promotional purposes. Please select one option:

Yes, I authorize public use: I give permission for Nature and Community Exploration Club to use identifiable photos and videos of my child in promotional materials, social media, websites, newsletters, and other public communications.

No public use of identifiable photos: I do not want identifiable photos or videos of my child posted publicly. Photos may be taken for internal documentation purposes only, and any public materials should not clearly show my child's face

REGISTRATION, TUITION AND FEES

There is a one-time, non-refundable $50 registration fee per family that covers enrollment costs. When you register for a club membership, your first month's tuition is due immediately and is non-refundable. This payment covers administrative costs, program planning, and supply procurement for your child's participation. Monthly Payments Due by the 15th of each month (half a month in advance). Late payments incur a $20 fee. Preferred: E-transfer to nature.community.ec@gmail.com Credit card available with 2.99% service charge (notify us in Lillio first) You're responsible for any NSF/returned payment charges plus applicable late fees Early dismissal pick-ups: $10 (waived for prepaid annual members) Extended days: $10/hour up to $85 maximum (arrange & pay in advance) Late pick-ups: $20 fee One full calendar month's notice required for any registration changes, withdrawals, or cancellations. Less than 30 days' notice still requires full monthly payment. Absences incur a $20 fee. No reimbursements for missed days.

GENERAL PROGRAM DETAILS

Our club memberships are annual commitments that secure your child's enrollment year-round. Tuition can be paid monthly or annually for your convenience. Club memberships include half-day nature exploration and outdoor experiences throughout the year. Club perks include: - Afternoon snack provided after school - 25% off for bus, birthdays, events, and discounted gear: hoodies/crews, hats, socks/gloves, towels, water bottles, stickers, hand-warmers, sunscreen, $5 eggs, and more! Little Explorers (Morning Program) | Monday through Friday half-day morning sessions. During July and August, we offer both AM and PM sessions—you can continue with your regular morning attendance or switch to afternoons by registration. After-School Explorers (2:30-5:30pm) | Follows the Surrey school district calendar. Day-Camps (9am-3pm) | During Pro-D days, spring break, and summer break, we offer full day-camp experiences. Pro-D Day-Camps | $65/day for non-members. Option to Pre-Pay for all Pro-D Days (includes early dismissals) $175 (Paid in Sept; Allowed up to 2 cancellations and ports to camp days) Spring and Summer Day-Camps | $65/day for non-members. Members have two options: 1. Apply monthly dues for their registered dates towards day-camps at a discounted top-up rate ($25 full-time members) or ($30 part-time members); or 2. Apply the monthly amount as a credit to use towards any regular rate camp days. We're closed on statutory holidays, two weeks in December (following Surrey School District calendar), and the last weeks of June and August. Fees are not pro-rated during closures.

DAILY PROGRAM REQUIREMENTS

Your child must be dressed appropriately for outdoor activities in all weather conditions. Required items include: - Rain gear and snow gear - Weather-appropriate footwear - Gloves and hats Leave a complete change of clothing, including socks and underwear, in a sealed jumbo ziploc bag for the duration of the year or summer season Being properly prepared is essential for your child's enjoyment and safety. Inadequate gear may result in a call for immediate pick-up or supply drop-off. Small snacks are included for Club members (low-cost for drop-ins) Large water bottles are mandatory Please provide additional food for children with sensitivities, specific preferences, growth spurts, or special dietary needs Little Explorer Toileting: Please inform us of your child's toileting independence level. While we have access to park washrooms, our staff cannot manage potty training or diaper changes. Pull-ups are welcome for children in transition.

HEALTH AND SAFETY POLICIES

The health and wellness of your children is our primary concern. We practice proper hand washing, allow for rest when needed, encourage healthy eating and body movement, and incorporate mindfulness, breathing, and nature connection into our daily routine. Illness Guidelines: To help prevent the spread of illness, please keep your child home if they have: - Cough or difficulty breathing - Fever (keep home for 24 hours after fever breaks) - Pain or debilitating injury - Sore throat - Stomach upset, diarrhea, nausea, or vomiting - Infected skin or eyes, or undiagnosed rash - A common cold that prevents play or participation If your child or anyone in your household has cough or flu-like symptoms, or has been in contact with anyone with COVID-19, please keep your child home. We will inform all parents of any illness outbreaks or contagious conditions. Medication: Prescription medication may only be administered after a parent or guardian has signed a Consent to Administer Medication form. Emergency Preparedness: We conduct periodic fire and emergency drills and teach children about emergency procedures in age-appropriate ways. Child Protection Policy: In accordance with the Child, Family and Community Service Act, we are legally required to report any suspected child abuse, physical harm, sexual abuse, exploitation, or need for protection to a child protection social worker. In British Columbia, a child is defined as anyone under age 19.

FINAL AUTHORIZATION

By typing my name below, I acknowledge that I have read and understand all sections of this authorization form. I agree to the terms and conditions outlined and take full responsibility for providing accurate and complete information about my child. I understand that this form is legally binding and that typing my name constitutes my electronic signature, indicating my informed consent to all aspects of my child's participation in Nature and Community Exploration Club programs.

Today's Date

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