West Coast Centre for Learning - Spring Equine Facilitated Wellness Program for Youth (Ages 8-12)_April 14

Spring Equine Facilitated Wellness Program for Youth (Ages 8-12)

10 occurrences

Tuesday 4:30 PM - 6:00 PM

April 14, 2026, April 21, 2026, April 28, 2026, May 5, 2026, May 12, 2026, May 19, 2026, May 26, 2026, June 2, 2026, June 9, 2026, June 16, 2026

$1,495

Pacific Riding for Developing Abilities

1088 208 Street, Langley, BC, V2Z 1T4

Pacific Riding for Developing Abilities

1088 208 Street, Langley, BC, V2Z 1T4

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Participant

Parent/Guardian

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Relationship

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Address *

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What is your preferred method of communication? *

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Emergency Contact

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Medical Questions

Family Doctor

Name of Practice *

Telephone *

First name *

Last name *

Email

Address *

City *

Country *

State/Province *

Zip/Postal code *

Personal Health Number *

Does your child currently have a diagnosis? *

Yes No

If yes, please explain.

Is your child on any medication? *

Yes No

If yes, please list and explain the purpose of the medication.

Does your child have any behavioural concerns that we should be aware of? *

Yes No

If yes, please explain.

School Information

Name of School Attending *

Is your child on a modified or adapted program? *

Yes, modified Yes, adapted No

What type of classroom setting is your child currently placed in? *

All day mainstreamed classroom Majority mainstream with some Special Education or therapeutic classes All day self contained Special Education classroom Majority Special Education with some general education classes Homeschool/Online School Situation Other

If other, please specify.

The following questions will help us to understand how your child is coping socially. *

Difficulty conversing with peers No friends at school Teased or bullied Never receives invitations for outside social gatherings i.e birthday parties/events Inappropriate friendships (younger/older teens) Self Isolating Aggression toward peers No social gatherings outside school Other

If other, please specify.

What special interests or activities does your child engage in?

How did you hear about us? *

Referred by Family or Friend Referred by a Professional ACT Community Training Internet Search Social Media Other

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

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

Yes No

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

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

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

If applicable, please provide the name of the school or funding source:

Please use the space below to share any questions, comments, or concerns you may have.

Parental Consent to Participate in the Program

I acknowledge that I am aware of the aims and structure of the program. I have had the opportunity to ask questions regarding the information provided and understand that I may seek clarification at any time to ensure my questions are answered to my satisfaction.

I understand that the personal information I provide will be kept confidential and used only for purposes related to participation in the program, in accordance with applicable privacy laws.

I have read and accept the above, and I give consent for my child to participate in the Equine Facilitated Wellness Program for Youth.. *

Equine Facilitated Wellness Program Statement of Agreement

Medical Release:
I, the undersigned, hereby declare that I am the parent or legal guardian of the child named above and that the information provided herein is complete and accurate to the best of my knowledge.

I authorize, in the event that all reasonable efforts to contact me or the designated emergency contacts listed above are unsuccessful, personnel of the West Coast Centre for Learning and Pacific Riding for Developing Abilities (PRDA) to seek and consent to medical treatment for my child by the physician identified above or, if unavailable, by another licensed medical professional.

I hereby release and discharge the West Coast Centre for Learning, PRDA, and their respective agents, employees, volunteers, and officers from any and all claims, demands, actions, or causes of action, whether known or unknown, which I, my heirs, executors, or assigns may have against them arising from or relating to any personal injury, illness, or medical treatment that my child may sustain while participating in the program or in connection with the provision of medical care.

I certify that my child is in good health and free from any communicable disease. I further certify that my child does not have any medical condition, injury, or physical limitation that would expose them to undue risk while participating in the program. Should my child have any such condition or injury, I agree to provide written notice to the program organizers prior to participation so that appropriate precautions can be taken to minimize risk.

By signing below, I acknowledge that I have read, understood, and voluntarily agree to this consent and release in accordance with the laws of the Province of British Columbia.

Health & Safety Measures
The health and safety of all visitors, employees, clients, and associates at Pacific Riding for Developing Abilities (PRDA) is our highest priority. If your child is unwell or exhibiting flu-like symptoms, please keep them home to protect the safety and wellbeing of all participants and staff.

Program Placement
Group placement is determined by qualified clinicians to ensure that the program is appropriate for each participant. Acceptance into the program is not guaranteed.

Payment
Payment is required at the time of registration for private registrations. For participants funded through the Autism Funding Branch (AFB) or a designated school, invoicing will be completed accordingly. If clinicians determine at registration that the program is not a suitable fit, a full refund will be issued.

Cancellation & Refund Policy
Participant placement is carefully considered to promote growth and a positive group dynamic. Cancellations can disrupt group cohesion and may, in some cases, result in the cancellation of a class, affecting all families. Please review program participation carefully before registering.

Cancellations made 30 days or more prior to the program start date will receive a full refund.
Cancellations with less than 30 calendar days’ notice will be subject to payment of the full program fees.
At the discretion of the Centre, participants may be allowed to transfer to a future session; however, no refund will be provided in such cases.
If program fees are being paid through external funding (e.g., school funding, Autism Funding, or third-party agencies), it is the responsibility of the registrant to ensure all fees are covered. Any portion not paid by the funding source remains payable by the family.

Statement of Understanding
I have read and understood the program description, policies, and procedures of the West Coast Centre for Learning and PRDA for the Equine Facilitated Wellness Program. I understand and agree with the philosophy and policies of the program and accept the terms and conditions set forth.

I acknowledge that failure to disclose pertinent medical, behavioral, or other relevant information may result in the removal of my child from the program.

By registering my child, I confirm that I understand and accept these policies and procedures. *

Please read and scroll to the bottom to accept.

Electronic signature

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Thank-you for completing our Equine Facilitated Wellness Registration Form for Youth.

Upon submitting this form, you will receive a copy of your invoice and your responses.

Once you click "Continue", you will be redirected to our payment page. If you are accessing funding for payment, please follow the instructions below.

Please select "Autism/School/Other Funding" on the payment page, confirm which method of funding you will be using, then click the "I Confirm" button.

Thank you for choosing West Coast Centre for Learning, we look forward to connecting with you. If you require immediate assistance, please feel free to contact us: info@wccl.ca or (778) 839-5515.

By submitting this form, you consent to West Coast Centre for Learning collecting and using your information to respond to your inquiry. For details on how your data is stored and protected, please review our Privacy Policy.