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Kindermusik
with Marilyn Manzer
How
to Register your Child
Please print out the registration form below, fill it in, and
return it to 53 Pleasant St., Wolfville, N.S. B4P 1M9 with a cheque equal
to at least the amount of the registration
fee. The balance of the fee may be paid in one cheque dated September 8, 2009 or two postdated cheques each for half the balance and dated September 8 and November 1, 2009.
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Registration Form
| Child's Name: |
| Parent's names: |
| Child's date of birth: |
Age
as of September 2009: ____ |
| Mailing Address: |
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Street
Address:
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Home phone: Work phone (Mom): Work phone (Dad): |
| Email address: |
| Caregiver's name and phone number (if applicable): |
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Parents
own or play any musical instrument? Specify:
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| How did you hear of my Kindermusik classes? |
| Do you consent to the listing of your telephone number on a
class list? Yes / No |
| Do you consent for me to use photos of you and/or your child
in Kindermusik class on my website? Yes / No |
Class enrolled for: Village ___ Our Time ___ Imagine That
___
Kindermusik for the Young Child Year 1 (4-6 yrs) ___ Yr.2 (5-7 yrs) ___ |
| Class time preferred ___________________________ |
| Signature:_____________________ |
Date:_________________ |
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___________ |
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+ Balance of Fee
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___________ |
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=
Total Fee
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___________ |
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- Discount for 2nd Child (10%)
|
___________ |
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=
Total with Discount
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___________ |
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Paid at time of registration:
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___________ |
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Post dated cheques: __________ and
|
__________ |
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