Kindermusik School Year Enrollment Form

Child's First Name

*

Child's Last Name

*

Birthdate (MM/DD/YYYY)

*

List siblings, if enrolling for Family Time:

Sibling Birthdates

Parent's First Name

*

Parent's Last Name

*

Street Address

*

City

*

State

*

Zip Code

Main Contact Phone # (with area code)

*

Alternate Phone Number

E-mail Address

*

Medical Problems/Allergies?

How did you hear about Kindermusik?

*

Visited Kindermusik.com
Visited Kindermusik with Ms. Danielle Website
Attended Demo Class
Saw Ad in Hooray for Families
Referred by a friend
Other

If you selected "Other" or "Referred by a friend", please explain:

Please select the appropriate age group for your child:

*

Select your first choice for class:

*

Select an alternate choice for class time:

*

I qualify for the following discounts:

I have more than one child enrolled this semester.
I save $15 on the Sign & Save with a Friend discount.
I have a child in the Little Learners MDO program.

Photo Permission

Yes, I give permission for use of photos/video of my child for advertising (with prior notification.
No, I do not give consent for use of my child's image in photograph or video.

I understand that I am responsible for paying for the class of my choice in a timely manner. No refunds are available except when written notice is given two weeks prior to the start of the class or under extreme circumstances.

*

Comments