Course Registration Form (Tuesdays 8-11 years)

Draw, Paint, Sculpt and Create

Tuesdays 4-6 PM | After school art program for children 8-11 years old.
Student Registration Form

Please fill out the form carefully for registration
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Please list any allergies.
Name of Child's School
School Name
Is pick up required from Palmerston Avenue Junior Public School

YES NO
If pick up from Palmerston is selected, please indicate your child's teacher's name:
Primary Parent/Guardian Contact Info
Parent/Guardian Name

First Name Last Name
Address

Street Address

Street Address Line 2

City
E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Emergency Contact
Emergency Contact
Full Name
Emergency Contact Phone Number
Course Selection
Please select the course and dates you are registering for:

Payment *

May 18 - June 29 (7 week session)

$ 210.00 CAD

Subtotal

$ 0.00 CAD

Tax

$ 0.00 CAD

Total

$ 0.00 CAD

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.
Note: Palmerston families, weather and time permitting we may stop for a 10 minute breather at Vermont Park on route to the studio.
Signature*
Should be Empty:

Draw, Paint, Sculpt and Create