Course Registration Form (Mondays)

Draw, Paint, Sculpt and Create

Mondays 4-6 PM | After school art program for children 7 - 9 yrs old.
Student Registration Form 2025-2026

Please fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Please list any allergies.
Name of Child's School
Name of School
YESNO
If pick up from Palmerston is selected, please indicate your child's teacher's name:
Primary Parent/Guardian Contact Info
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province
E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Phone Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Emergency Contact
Emergency Contact
Full Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Course Selection
Please select the course and dates you are registering for:

Payment *

8 week session

All sessions are 8 wks unless specified

$260.00CAD

3 Week Session

June 8th - June 22nd

$105.00CAD

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

I, First Name* Last Name* ,HEREBY WAIVE ANY CLAIM AGAINST ANNEX ART CENTRE AND IT’S STAFF THAT MAY ARISE FROM ANY PHYSICAL INJURY THAT MY CHILD MAY INCUR WHILE PARTICIPATING IN THE ANNEX ART CENTRE WORKSHOPS.

Signature
Signature
Signature
Should be Empty:

Draw, Paint, Sculpt and Create