Music Play Registration Form
For the Early Childhood Music Class "Music Play" for Spring 2018.

Wednesdays at 5:30pm

Saturdays at 9:30am

Payment in entirety is due on the first day of class unless prior arrangements have been made with the Director.

Classes are approximately 45 minutes long.

Student Last Name *
Your answer
Student First Name *
Your answer
Parent Name(s) *
Your answer
Address *
Your answer
Phone Number (most used) *
Your answer
Additional Phone Number (in case of emergency) *
Your answer
Parent Email Address *
Your answer
Parent who will usually attend class with child: *
Your answer
Student's Birthdate *
MM
/
DD
/
YYYY
Student School (if applicable)
Your answer
Please list any special needs, learning or behavior disabilities, or dietary restrictions.
Your answer
Other activities the child participates in: *
Your answer
Student or parent goals, wishes, hopes, dreams, desires for music class: *
Your answer
Class Time Registering For *
How did you hear about this class? *
Your answer
Additional comments or questions for us:
Your answer
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