Lunch Time Program Registration Form

VENTURA PARK P.S. LUNCH TIME PROGRAM REGISTRATION FORM

M.Y.S.A. Kidz DRAWING & ILLUSTRATION

VOL.2

WEDNESDAYS JANUARY 13

– MARCH 2

2016

TH

ND

M.Y.S.A. Kidz is very excited to be returning for Drawing & Illustration Vol.

GRADES 1-7

(co-ed)

2! Get ready for more cool and creative drawing projects and take your

talents to the next level learning cartooning, figure drawing, animation,

8 WEEKS

color patterns and much more. Each week learn a new drawing concept that

$95 per student

(1:00pm-1:40pm ROOM 229)

can be practiced and applied to any of your art projects.

***NOTE: REGISTER ONLINE AT CHECKS ARE MAILED TO 32 Oakmount Cres, Concord, ON L4K-2C3***

Student Name: __________________________________ Teacher: _____________________________________ Grade: ________________________________________

Parent One Name: _________________________________ Phone: # _________________________________

Parent Two Name: ________________________________ Phone: # _________________________________

Emergency Contact: _______________________________ Phone: # _________________________________ Relationship to Child: ____________________________

E-Mail Address: ________________________________________________________________________

Does your child have any medical conditions that the programs Coordinators need to be aware of? NO If YES, Please explain

___________________________________________________________________________________________________________________________________________________

Is your child on any medication or have any allergies that our coordinators need to be aware of? NO, YES Please List

___________________________________________________________________________________________________________________________________________________________

Do you grant MYSA Kidz permission to photograph your child for website gallery? YES______ NO______

I hereby release, waive, discharge and covenant not to sue or otherwise claim or proceed against any of the listed programs above, their owners, affiliated organizations, their respective management, administrators, directors, agents,

coaches, employees, sponsoring organizations, sponsors, advertisers and if applicable, owners and /or lessees of premises used to carry out any program administered by any of the above listed (collectively the “Protected Parties”)

from any and all liabilities to the undersigned, his or her heirs and their next of kin for any and all claims, demands, losses or damages on account of injury, damage to property, caused, alleged to be caused or in any way connected the

participation in any program administered by any of the above listed programs.

Signature ________________________________________ Print Name___________________________________________________ Date ______________________________

***For more information please contact us (416) 509-9354

visit our website:

NOTE: If you have registered your son or daughter consider them part of the program. Please send payment right away as a spot will be

reserved for them. MYSA Kidz does not offer refunds but will credit you for another program if requested.