Reservation Form

Please Print, include payment and Mail to:

Julie Stewart

Kindermusik of Clayton

100 Cunningham Lane, Suite 106

Clayton, NC 27527

Child’s Name: _____________________________

Child’s DOB: _____________________________

Desired Day/Time: _________________________

Alternate: ________________________________

Est. Number of Children: _____ Plan Desired: _____

Extras: ___________________________________

Contracted Number of children needed 10 days in advance.

Parent’s Name: ____________________________

Address: ________________________________

City: _______________State:____ Zip: _________

Home Phone: _____________________________

Work Phone: ______________________________

Cell Phone: ______________________________

Email Address: _____________________________

How did you hear about us? ___________________

Referred by: ______________________________

( ) Cash ( ) Check ( ) Credit Card

Visa, Mastercard, Discovery, American Express (circle)

Name on Card _____________________________

Expiration Date: ___________ Security Code: _____

Card # _________________________________

Billing Address: ______________________

__________________________________

Amount enclosed: __________Date:______

One half due one month before party,

Balance due 48 hours before party.

Signature: ________________________________

(Signature authorizes charges for Birthday Party.)

Kindermusik of Clayton

& Voice of Clayton

100 Cunningham Lane suite 106

Clayton, NC 27527