First Name *

Last Name *

Country / Region *Canada

Street address *

Apartment, suite, unit, etc. (optional)

Town / City *

Province * Select an option…AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Postcode *

Phone *

Email Address *

Name of person(s) picking up child *

Phone number of the person picking up child  *

What are your expectations for this class? How do you or your child hope to benefit from participating in this class? *

Please comment on the student’s past art experiences, learning style, personality or any other information that may be helpful in teaching your child. We need to be aware of any giftedness or learning/discipline challenges. All information is strictly confidential *

Any allergies to medication, insects, food etc.: *

Any underlying medical conditions in which we need to be aware:  *

What is the best way to reach the primary parent *Cellular PhoneEmail

Emergency Contact 1 Name *

Emergency Contact 1 Phone *

Emergency Contact 2 Name *

Emergency Contact 2 Phone *

In order to track our advertising and reward referrals, please tell how you found out about Aliki’s Art House.  * Past StudentPostcardFriend or RelativeCalgary's ChildOnline ArticleGoogle SearchFacebookSignOther

Friend or Relative name, Sign location or Other *

Please sign below to give permission to photograph you or your work for any Aliki’s Art House special events, advertisements, and/or promotional material including but not limited to website, emails, Facebook and Kijiji. *I give permissionI DO NOT give permission

Full name (optional)

Email address (optional)

Please read the following waivers and agreements carefully. They include release of liability and waiver of legal rights, and deprive you of the ability to sue certain parties. By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the registration process.

I agree to the Aliki’s Art House Fine Art Classes Consent and Release Form This field is required. *

Type your signature *

Secondary Parent Phone Number (optional)