To register for Surreybrook, there are 2 options:

  • Request an electronic form – We email it 1 or 2 parents to be completed and signed. To use this option, please contact us.
  • Print, Complete and Dropoff or Mail the paper form.

Credit Card Authorization

To pay with a credit or debit card, use the authorization below to submit your card information.
You will need your payment amount and frequency and you will need a mobile phone to receive a verification text message to complete the process.
Click here to submit your payment details securely online. Submit Credit Card Authorization Details  

Alternatively, you can Download the form to print & dropoff at the office.


Electronic Forms

For the forms below, click the link to get the electronic version and sign online.

Authorization for the Application of Non-Prescription Topical Medications

Credit Card Authorization Form