Family Music Class Registration Form
Music on the Move provides Early Childhood Music Education for Families and Schools in the Cedar Rapids Area.
Lisa is passionate about empowering YOU to sing, play, listen, laugh, move, learn and bond with your newborn through 5-year-old. Our weekly, 45 minute Family Music class provides the opportunity to PLAY while exploring songs, instruments, games, rhythms, chants, movement, sign language, and a variety of musical styles. Lisa is a board-certified music therapist - ALL children are welcome! See more at www.mymusiconthemove.com
Your First Name
Your answer
Your Last Name
Your answer
Relationship to the child
Please note if someone other than you will generally be bringing your child to class.
Your answer
Email
Your answer
Phone number
For class cancellations
Your answer
Can I send a text message if class is cancelled?
Child's Information
Child's Name
First & Last
Your answer
Child Birthday
Used only so I can keep track of how old everyone is!
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Child's Name (#2)
First Last
Your answer
Child's Birthday (#2)
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Child's Name (#3)
First Last
Your answer
Child's Birthday (#3)
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YYYY
Permission to photograph
I give permission for the above named individuals to be photographed during Music on the Move classes. Photos will become the property of Music on the Move and may be used for advertising purposes including, but not limited to, internet and website promotion, studio and window displays, fliers, and mailings. Consent can be withdrawn at anytime in writing to Music on the Move, 109 19th Ave Ct, Hiawatha IA 52233.
Personal Photos Policy:
Our classes are very fun and exciting and an experience we hope you will cherish for a lifetime. You are welcome to capture this experience on film provided that your child is not left unattended and you are not disrupting the class. In addition, please be very careful to refrain from publicly posting (including social media sites) any photos of children that are not your own unless you receive consent from their parent.
Assumption of Risk and Waiver of Liability:
I acknowledge that participation in this program requires my own alertness to the safety of my child(ren) and therefore hereby release Music on the Move from such responsibility. By typing my name below, I agree to all terms and conditions above.
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How did you hear about Music on the Move?
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