Preschool Play Music

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Student's Name *

Student's Age *

Student's birth month

Parent or Guardian's Name *

Home Phone

Cell Phone

Work Phone

Address

The regular class day/time is Tuesdays at 3:30. However for the trial period an extra class will be added.

For planning purposes for extra class times, please indicate whether you are available on the following days and times. You may make further comments in a comment box below.

I am available Tuesday, September 26th at 3:30

I am available Thursdays, Sept. 28th and Oct. 5th at 3:30 or 4:00

I am available Saturdays, Sept. 30th and 7th around 10 or 11 am

I am available Wednesdays, Sept. 27th and Oct. 4th around 4:30

If you have any comments regarding scheduling, please add here, or text me @ 581-0052

Payment *

Payment must be received for your child to be officially registered for the class. If payment is not received within 2 days your student may be bumped onto the waiting list and their spot given to another. Please indicate by which method you intend to pay below.

Check or Money Order

Credit Card through PayPal - button to the right on the page.

Cash - you must see me in person, this is only an option if you have an appointment with me.

Required

Policies *

Please check to indicate you have read Policies on the Preschool Play Page and agree to abide by them read on right side of this page --->

I understand the Policies and agree to abide by them.

Required

Questions, Comments? Write below, or text me @ 581-0052

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