Course Registration Form (Wednesdays 12 years+)

Draw, Paint, Sculpt and Create

Wednesdays 4-6 PM | After school art program for children 12 years and up.
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.
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 *

8 Week Session All sessions are 8 weeks (except for June 1 – June 29, 2022). If you are registering for June 1 - June 29, please select the 5 week pricing option below.

$ 240.00 CAD

5 Week Session (June 1 – June 29, 2022)

$ 150.00 CAD

Subtotal

$ 0.00 CAD

Tax

$ 0.00 CAD

Total

$ 0.00 CAD

Credit Card

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

Student Registration Form

Primary Parent/Guardian Contact Info

Emergency Contact

Course Selection

Credit Card