Name Birthdate dd/mm/yy Guardian Address Authorized Pick-up       City Postal Code Home Phone Cell/Work Phone Emergency Contact     Emergency Phone     E-mail     Allergies or special needs Desired Week Course Name zMiniArt + Music - Fall Termz     Day/time of classes Wednesdays 9:30am - 11:30 am     Course Fee $429.00     Materials Fee Materials & healthy snack included     Total Cost $429.00