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 zPainting through the Agesz     Day/time of classes Tuesdays, 4-5:30 - SK to Gr. 3 Thursdays, 4-5:30 - Gr. 4-6 Saturdays, 1-2:30 - Gr. 1-4     Course Fee $334.00     Materials Fee included     Total Cost $334.00