SURPASS 2009 - A SelfDesign Summer Program
SURPASS Registration - 2009     


Both the applicant and primary parent/guardian are required to fill in the information below.


Applicant Personal Information
Parent/Guardian Contact Information
*(required field)    
*FirstName: *FirstName:
*LastName: *LastName:
 SecondName:
 (if applicable)		 *Street:
 Usual Full Name:
 (if different)
*City:
*Gender: Male Female *Province:
*BirthMonth: *Postal Code:
*BirthDay:

*Home Telephone:
(area and number)

  
*BirthYear: *Email: (must be valid)

       

*(For applicant) - Why I wish to attend and participate in SURPASS
this coming summer (please provide some details):

 
Special Needs or Requirements (if any):

 

*I have read the overview of SURPASS and am fully aware of the nature of this program - both applicant and parent.

* I have read and understand the following:

The total fee for participating in SURPASS from July 12-19 2009 at Camp Byng on the Sunshine coast is $450. To ensure registration, applicants must provide a deposit of $100 by March 15th, 2009. The non-refundable portion of the registration fee is $50. The balance of $350 is due by May 15.

*Payment Options

My son/daughter is presently enrolled in SelfDesign Learning Community.

I agree to apply the applicant's SelfDesign Learning Investment toward the SURPASS registration fee. I will make a cheque request through the Planner system payable to SURPASS. SURPASS will invoice us directly for any remaining balance.

I will pay by cheque in one or two installments. (Either a $100 deposit or full $450.00 tution please.)

If you make a $100 deposit now, you will need to pay the balance of $350 by May 15, 2009.

Please make your cheque(s) payable to: Wondertree Foundation - SURPASS Retreat

Please mail the cheque to:
Wondertree Foundation - SURPASS Retreat
Kitsilano PO Box 74560
Vancouver, BC, Canada
V6K 4P4