B.I.L.Y. B. Music
Registration form for Spring, 2017
Email address *
Little's Name: *
Parent/Guardian Names: *
Little's Date of Birth
Names of additional adults attending classes: *
Names of siblings or other children at home: *
Names and birthdays of of siblings attending classes:
Please share additional sibling info (preferred songs, games, etc).
Telephone numbers (please mark preferred with a *): *
Your preferred number will be called in case of an emergency
Preferred e-mail: *
Emergency contact person and relationship: *
(please include this individual's telephone number)
Please list any allergies, illnesses, or medications: *
This information will be kept confidential, but is necessary to provide the best services!
What does your child do well? *
Does your child have preferred music or toys? *
Please feel free to share any additional notes or concerns!
This helps me get to know you a little better!
Please indicate below if you would like your child's picture to be used on any Studio B | Music for Living publications or social media. *
Please note: all pictures and videos are done so with individual purpose permission.
According to the CDC, illnesses are contagious when the individual is running a fever. Due to the nature of the B.I.L.Y. B. Music classroom, we strongly recommend that you not bring your child to class if he/she is ill. We love to share here at Studio B, but not where germs are concerned! We know that you know your child best, so if you think they're under the weather, please stay home! *
Please check your acknowledgement below:
How would you like to be contacted in case of a cancellation? *
Please list the telephone number and/or e-mail address at which you would like to be reached for cancellations. *
I acknowledge that payment for B.I.L.Y. B. Music classes are due in full at the first class. *
Failure to provide funds within the first week of classes will result in the termination of services, and the spot going to a family on the waiting list.
Which class time are you signing up for? *
I acknowledge that classes that do not meet enrollment minimums will be cancelled. *
If you were referred to Studio B by a friend, please list their first and last name below so they can receive their bonus course materials! *
Please click the link below to make your payment, completing your registration! *
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