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Haworth: Winter 2020 Registration
Please use this form to register for Music Speaks Winter 2020 Classes at Haworth Public Library, 165 Stevens Place, Haworth, NJ 07641
Email address *
Parent/Caregiver (First & Last Name): *
Your answer
Street: *
Your answer
City: *
Your answer
Zip Code: *
Your answer
Parent Home Phone: *
Your answer
Parent Cell Phone: *
Your answer
Emergency Contact (First & Last Name): *
Your answer
Emergency Contact Phone Number: *
Your answer
Child's Name (First & Last): *
Your answer
Date of Birth: *
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DD
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YYYY
Photo Consent (please indicate Yes or No): *
Allergies: *
Your answer
Class Selection (First Choice): *
Class Selection (Second Choice): *
Do you have questions for Wendy?
Your answer
By registering and signing below, you are authorizing your child to participate in all class activities. You assume all risks normal to these activities and absolve Music Speaks LLC of all present and future liability in the event of accident or injury.
Parent or Caregiver Signature *
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