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 postdated for January 15th 2008 or two postdated cheques each for half the balance and dated January 15th and March 1st 2008. Cheques are payable to Marilyn Manzer.

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Registration Form

Child's Name:
Parent's names:
Child's date of birth:	Age as of January 2008: ____
Mailing Address:
Street Address:
Home phone: Work phone (Mom): Work phone (Dad):
Email address:
Caregiver's name and phone number (if applicable):
Parents own or play any musical instrument? Specify:
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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