Request to Register | Spring Break Camps 2020

Spring Break Camps 2020 - Request to Register

This form is to request registration for your child in the upcoming Spring Break Movement & Mindfulness Camps.

Registration requests may be denied if your registration was received after all available spots have been filled, or after the registration cut-off date. In this case your credit card will not be charged and you will be contacted.

If your child has successfully been registered for a camp, you will receive booking confirmation emails, as well as an emailed intake form and receipt of your payment.

Please allow 1-2 business days for your request to be processed.

This class is to be held at Reach, at 5050 47th Ave. Ladner.

How many children will you be registering?*
If registering over four participants, please call 604-283-7827 ext.0 to register.
Participant #1
Participant #1 Name*
First Last
Participant #1 Age*
Ages 3-5
This child will be registered for the March 16-20 camp.
Ages 6-9
This child will be registered for the March 23-27 camp.
Participant #2
Participant #2 Name*
First Last
Participant #2 Age*
Ages 3-5
This child will be registered for the March 16-20 camp.
Ages 6-9
This child will be registered for the March 23-27 camp.
Participant #3
Participant #3 Name*
First Last
Participant #3 Age*
Ages 3-5
This child will be registered for the March 16-20 camp.
Ages 6-9
This child will be registered for the March 23-27 camp.
Participant #4
Participant #4 Name*
First Last
Participant #4 Age*
Ages 3-5
This child will be registered for the March 16-20 camp.
Ages 6-9
This child will be registered for the March 23-27 camp.
Contact Information
For parents or guardians.
Name of Primary Contact*
First Last
Cell Phone of Primary Contact*
Email of Primary Contact*
Name of Secondary Contact*
First Last
Cell Phone of Secondary Contact*
Does your child have any allergies?*
Please list any allergies*
Please list any diagnoses or medication, if any.
Cancellation/Refund Policy*
Refunds will only be given up to 2 weeks prior to the start of the program. After this period, no refunds will be given. This group program is offered as a whole. Refunds or rescheduling will not be available for missed classes.
I agree to the cancellation/refund policy.
Credit Card Information

If your registration request is accepted, your card will be charged a one-time fee for this registration. You will be emailed a payment receipt.

If spots are no longer available your card will not be charged, and you will be contacted.
Name of Cardholder*
Account Type*
Account Number*
Expiration Date*
Please enter in "01" for the expiration day.
YYYY
MM
DD
3 Digit Security Code*
You can typically find this number on the back of your credit card.
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Credit Card Authorization*
I authorize Alongside You to charge the credit card indicated in this form, for a one-time payment according to the terms outlined above, and according to the Alongside You cancellation policy. I authorize Alongside You to charge my account for services rendered. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.
Signature*
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Spring Break Camps 2020 - Request to Register

Participant #1

Ages 3-5

Ages 6-9

Participant #2

Ages 3-5

Ages 6-9

Participant #3

Ages 3-5

Ages 6-9

Participant #4

Ages 3-5

Ages 6-9

Contact Information

Credit Card Information

Opening Hours