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REGISTRATION FORM

 

 

   

Registration Form

Map

Please print, fill out, include payment and mail

       or to Register Online press this link.                       

Call 359-3473 to check availability.

Annual Family Registration Fee of $25.00

Watch for Early Bird Specials to waive this fee.

 

 

PARENT INFORMATION

Parent Name:________________________________________

Address:____________________________________________

City: _________________________State:____  Zip:________

Home Phone: ______________Cell Phone: ______________

Work Phone: ________________________________________

Email Address: _____________________________________

Emergency Contact: ________________________________

Emergency Phone: __________________________________

How did you hear about us? ________________________

Referred by: _______________________________________

CHILD INFORMATION - 1

Child Name: _______________________________________

Child DOB: ________________________________________

Desired Class/Day/Time:___________________________

Alternate: _________________________________________

CHILD INFORMATION - 2

Child Name: _______________________________________

Child DOB: ________________________________________

Desired Class/Day/Time:___________________________

Alternate: _________________________________________

 

METHOD OF PAYMENT/Amount enclosed

(   ) Cash  (  ) Check   (  ) Payment Plan /  $___________

( ) Online Registration (  ) Credit Card Type __________

Name on Card:______________________________________

Expiration:___________________ Security Code::________

Card#:______________________________________________

 

Signature: __________________________________________

(Signature authorizes charges for Kindermusik

Registration, Materials and Tuition.)

 

Make check payments to

Julie Stewart

 

and mail to address below

 

Kindermusik of Clayton & Voice of Clayton

100 Cunningham Lane, Suite 106

Clayton, NC  27527

 

Kindermusik of Clayton

& Voice of Clayton

100 Cunningham Lane suite 106

Clayton, NC  27527

©2007 webmaster: Julie Stewart