West Coast Centre for Learning - Secret Agent Society Spring Camp Registration_March 16

A grade 3 level of reading is required to participate in the program.

Secret Agent Society (SAS) Social Skills Spring Camp

Now accepting registration for children ages 8-12

No upcoming class

9:00 AM - 2:30 PM

March 16, 2026, March 17, 2026, March 18, 2026, March 19, 2026, March 20, 2026

$1,595

The Professional Centre, Building C, 4/F, Suite 402

3211 152nd Street, Surrey, BC, V3Z 1H8

The Professional Centre, Building C, 4/F, Suite 402

3211 152nd Street, Surrey, BC, V3Z 1H8

Parent/Guardian

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Relationship

First name *

Last name *

Email *

Mobile *

Address *

City *

Country *

State/Province *

Zip/Postal code *

Other phone (home or work)

Other Parent/Guardian (optional)

Relationship

First name *

Last name *

Email

Mobile *

Address

City

Country

State/Province

Zip/Postal code

Other phone

Current marital status of biological parents *

Married Separated Divorced

Other

Where does the child reside? *

Please describe common situations where your child might feel anxious, angry or frustrated. *

Are there any changes that occur in your child's behaviour when they feel anxious, angry or frustrated? *

i.e. changes in body posture, voice, tone, muscle tension, changes in facial expression...

Yes No

If yes, please explain

Has your child received therapy or support to cope with their emotions, social skills or ability to get along with others? *

Yes No

If yes, please describe

Has your child undergone a Psych Ed Assessment in the past 2 years? *

Yes No Currently undergoing assessment

Upload Current Psych-Ed Assessment here

If you answered "yes" to the above question, we would find it helpful if you could share the results of the assessment report with us. All files are kept strictly confidential and all staff are bound by a confidentiality agreement.

Name of School Attending *

Child's Teacher

First name *

Last name *

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Email *

Telephone

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Can your child read at a Grade 3 level or above? *

Yes No

Does your child receive any additional assistance at school? i.e. Learning Support, on an IEP? *

Yes No

Does your child have access to a device with internet access that they can use for the duration of the camp? i.e. tablet or laptop *

Yes No

Is English your child's first language? *

Yes No

How would you rate how well your child speaks and understands English? *

Very Well Well Reasonably Well Poorly Very Poorly

What hobbies or interests does your child currently have? *

Is your child is experiencing any problems making friends, problems choosing the right friends, anxiety, anger, impulse control, difficulty adjusting to changes in routine? *

Yes No

If yes, please explain

Parental Consent to Participate in the Program

I am aware of the aims and structure of the program. I have had the opportunity to ask any questions arising from the information provided and/or will seek out answers so that questions will be answered to my satisfaction. The information that I provide will be kept confidential.

I have read and accept the above, and I give consent for my child to participate in the Secret Agent Society Spring Camp Program *

Secret Agent Society Spring Camp Statement of Agreement:

Medical Release:
I hereby declare that I am the parent or legal guardian of the above-named child and that the information I have given is accurate.

I give my consent, in the event that all reasonable attempts to contact me or designated persons above have been unsuccessful, to West Coast Centre for learning personnel to seek medical treatment by the physician named above, or in the event the preferred practitioner is not available, by another licensed medical professional.

I hereby release and discharge West Coast Centre for Learning, it's agents, employees, and officers, from claims, demands, actions, or judgements which the undersigned ever had, now has or may have against West Coast Centre for Learning, it successors, or assigned, for all personal injuries or illness, which the child named above may suffer or incur as a result of the actions of West Coast Centre for Learning or in procuring medical treatment.

I certify that the child named above is in good health and free from communicable disease or illness.

Statement of Understanding:
I have read the program description, policies and information, and procedures of West Coast Centre for Learning and Secret Agent Society Spring Camp Program. I understand and agree with the philosophy and policies; I accept the conditions and terms stated therein.

I have read and agree to the above. *

Please read and scroll to the bottom to accept.

I consent to having photographs and work samples of my child/ren used by West Coast Centre for Learning in promotional material. * *

Yes No

Will you be accessing funding to pay for the program? *

Yes, Autism Funding Yes, School Funding No, bill me privately

How did you hear about us? *

Internet Search ACT Community Training Referred by a friend or professional Social Media Other

If by family/friend, please list their name below. If by other, please specify.

Would you like to receive our newsletter with helpful parenting tips, program information, and special offers. (You can unsubscribe at any time) *

Yes please! No thanks.

Electronic signature*

Please sign your name inside the box

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Thank you for choosing West Coast Centre for Learning, and for completing our Secret Agent Society Spring Camp Registration Form. After clicking "Continue", you will be directed to our payment page.

Autism/School Funding:
If you are accessing funding for payment, please select "Autism/School Funding" on the payment page, confirm which method of funding you will be using, then click the "I Confirm" button.

If you require immediate assistance, please feel free to contact us at (778) 839-5515 or info@wccl.ca.

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