C1 art space

Registration Form

Please read all general info regarding

art classes before filling out this form.

Name______________________________________________

Tel. Day____________________________________________

Tel. Evening_________________________________________

e-mail______________________________________________

For Children:

Guardian Name______________________________________

Emergency Contact___________________________________

Tel.________________________________________________

Is there anything we should be aware of? (allergies, etc.)

___________________________________________________

Indicate Course(s) and time:

___________________________________________________

___________________________________________________

Course Amount____________________

Cheque______ Visa_______ MC_______

Credit Card #________________________________________

Expiry Date_________________

Waiver

The undersigned states that they are aware that while all reasonable safety practices and precautions will be exercised, by C1 art space, C1 art space will not be held liable for any type of injury, illness or loss due to the use or misuse of any school property and materials while a student a C1 art space.

Signature___________________________________________

Date______________________________________