Registration Form - Weekly Art Program

Registration: Weekly Art Program (Spring 2026)
Program Information
- Progam: Weekly Art Foundation Program (8 sessions)
- Time: 6 pm – 7:30 pm
- Days: Mondays, starting April 13th up to and including Jun 8th (note, no class on May 18th)
- Location: Clearview Academy (2828 Kingsway Drive, Unit 6, Oakville, ON L6J 7M2)
Fees
$ 200 per child
Clearview Academy email
example@example.com
Student Information
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Student's Current Grade (2025-26 school year)*
School*
Parent Information
Parent Name*

First NameLast Name
Parent Email Address*
example@example.com
Parent Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact / Secondary Parent Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to student*
Medical Information and Allergies
No known medical conditions, allergies or special needsYes
NoYes
Please list all known allergens:*
NoYes
Please describe medical conditions:*
NoYes
If yes, please describe*
NoYes
If yes, the parent agrees to provide

• One (1) current, unexpired auto-injector
• Clear labeling with the student’s name
• Replacement medication prior to expiry
Epinephrine Injector Expiry Date:*

MonthDayYear
Carried by the student
Please provide any additional details Clearview Academy should be aware of regarding your child, if applicable
Emergency Response Authorization & Release
By signing this form, the parent authorizes Clearview Academy, its directors, employees, contractors, and agents to administer epinephrine where staff, acting reasonably and in good faith, believe the student is experiencing an anaphylactic reaction.

In the event of suspected anaphylaxis, staff will:

1. Administer epinephrine immediately;
2. Call 911;
3. Contact the parent/guardian;
4. Remain with the student until emergency services arrive.

Epinephrine may be administered without prior parental contact in emergency circumstances.

To the fullest extent permitted by Ontario law, the parent/guardian agrees to release, indemnify, and hold harmless Clearview Academy (Rangan-Lonkar Tutoring Inc.), its directors, employees, contractors, and agents from claims arising from:

• Administration of epinephrine in good faith;
• Failure to administer epinephrine where symptoms were not reasonably apparent;
• Allergic reactions occurring during Academy programming;
By signing this form, the parent confirms that all information provided above is accurate and agrees to notify Clearview Academy immediately of any changes.
Drop off and Pick up Details
Dropped off by parent/guardian
Picked up by parent/guardianPicked up by individuals listed below
Alternate Pick up Name*

First NameLast Name
Alternate Pick up Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Pick up Name

First NameLast Name
Alternate Pick up Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
By signing this form, the parent/guardian acknowledges that Clearview Academy is not responsible for the child's actions once the child leaves Clearview Academy
Cancellation Policy
a. Cancellations within 14 days of camp date (mentioned above): No refunds can be issued, as materials and staffing will have already been confirmed. We’re happy to offer credit (program fee paid, less $50 administrative fee) toward a future camp or workshop, subject to availability. Requests must be submitted via email to: admin@clearview-academy.ca
Liability Waiver, Assumption of Risk & Indemnification
I, the undersigned parent or legal guardian, acknowledge and understand that participation in programs at Clearview Academy (Rangan-Lonkar Tutoring Inc.) involves inherent and foreseeable risks associated with being in an educational environment, including but not limited to minor injuries, illness, allergic reactions, or other incidents that may occur while on the premises or during supervised activities.

I acknowledge that Clearview Academy (Rangan-Lonkar Tutoring Inc.) does not guarantee an allergen-free environment. While reasonable precautions will be taken, the Academy cannot eliminate the risk of exposure to food or environment allergens brought onto the premises by students, staff or visitors.

I voluntarily assume full responsibility for any and all risks, known or unknown, associated with my child’s participation in programs at Clearview Academy. This includes any risk associated with my child walking home by themselves (if I have selected that option above) once the class is done. I acknowledge that Clearview Academy cannot be held responsible for my child’s actions or safety once my child leaves the Clearview Academy center.

To the fullest extent permitted by the laws of the Province of Ontario, I hereby waive, release, and discharge Clearview Academy (Rangan-Lonkar Tutoring Inc.), its owners, directors, officers, employees, tutors, independent contractors, volunteers, and agents from any and all claims, demands, actions, damages, losses, costs, or expenses arising out of or related to my child’s participation, except where such claims result from the gross negligence or willful misconduct of the centre.

I further agree to indemnify and hold harmless Clearview Academy (Rangan-Lonkar Tutoring Inc.) from and against any claims, liabilities, damages, losses, or expenses (including reasonable legal fees) arising from my child’s actions, failure to disclose medical information, or breach of center policies.

This waiver shall remain in effect for the duration of my child’s enrolment and shall be binding upon me, my child, and our respective heirs, executors, administrators, and legal representatives.

Clearview Academy (Rangan-Lonkar Tutoring Inc.) collects personal information for the purpose of student registration, program administration, communication with parents/guardians, billing and student safety. Information is protected with appropriate safeguards and accessed only by authorized personnel. Informaiton may be stored or processed by trusted third-party services providers, including providers located outside Canada and may be subject to the laws of those jurisdictions. While reasonable safeguards are used to protect personal information, no method of electronic transmission or storage can be guaranteed to be completely secure. By signing below, I consent to the collection, use and disclosure of personal information for these purposes.
Program Payment

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Via Credit Card

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Weekly Art Program - Spring 2026

Fees for the weekly Art program (Spring 2026)

$200CAD

Enter coupon

Total

$0.00CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature of Participant or Parent/Guardian (if under 18)*

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I UNDERSTAND THAT BY ENTERING MY DIGITAL INFORMATION ABOVE, I AM SIGNING THIS DOCUMENT. I confirm I have read, understand, and agree to all terms and policies presented in this agreement, including pick-up authorization, snack and lunch responsibility, cancellation, and all waivers and releases above.
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Registration: Weekly Art Program (Spring 2026)

Program Information

Fees

Student Information

Parent Information

Emergency Contact / Secondary Parent Information

Medical Information and Allergies

Emergency Response Authorization & Release

Drop off and Pick up Details

Cancellation Policy

Liability Waiver, Assumption of Risk & Indemnification

Program Payment