Enrolment & Payment Checkout

First Name *

Last Name *

Country  *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 *

Please comment on any past art experiences. *

Please share learning style, personality or any other information that may be helpful for our instructors to know. It is valuable for us to be aware of giftedness or learning/discipline challenges. All information is strictly confidential. (optional)

What are the expectations or goals for this class? Parents, how do you hope your child will benefit from participating in this class? Adults, why are you taking this course? *

Please share any underlying medical conditions in which we need to be aware. *

Please share allergies to medication, insects, food, etc. Let us know if participant has an EpiPen or other required medications. *

Emergency Contact 1: Full Name For children, must be other than the parent/guardian. *

Emergency Contact 1: Phone *

Emergency Contact 2: Full Name (optional)

Emergency Contact 2: Phone (optional)

Primary Parent/Guardian: Full Name (optional)

Primary Contact: Phone (optional)

Primary Contact: Email address (optional)

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

Secondary Parent/Guardian: Full Name (optional)

Secondary Contact: Phone Number (optional)

Name of person(s) picking up child (optional)

Phone number of the person picking up child  (optional)

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

Tell us the name of your friend or relative name. Where did you see the sign? Other? (optional)

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

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

Type your signature *

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.