Register

Contact Information

Your Name*

FirstLast

Email*

Home Phone*

Cell Phone

Are you currently an enrolled Music and My Child family?*

Yes
No

New Family Information

Address*

Street AddressAddress Line 2CityStateZip Code

How did you hear about us?*

Name of Friend or Other Way You Heard About Us:

Student Information

Name*

FirstLast

Age*

Date of Birth*

MM

DD

YYYY

Add enrollee from the same family?

Name*

FirstLast

Age*

Date of Birth*

MM

DD

YYYY

Scheduling Information

Studio Location*

Kindermusik Class*

Class Day and Time

1st Choice*

Day & Time

2nd Choice

Day & Time

Check all that apply.

Check here if you referred a new Kindermusik family to our program. (Please provide name below.)
Check here if enrolling siblings in the same class.
Check here if you are enrolling a sibling in different classes. We will deduct $20 from the siblings tuition.
Check here if you are repeating a curriculum you have done before.
Medical condition/Allergies

Name of friend you referred:*

Payment Method*

Cash or Check
Credit/Debit Card

If you select Credit/Debit, you will be taken to a payment page after submitting this form where you may make your payment through PayPal. No account creation is necessary.

Policies for Credit Card Payment

You have my permission to email class-related information and announcements. I understand that my personal information will not be released to any third party, and is for the exclusive use of communication from Music and My Child. I hereby authorize Music and My Child to apply the fees (less any discounts) to my credit card. I understand that the deposit is non-refundable and will be charged to my account along with the first tuition payment. I understand and agree to the payment schedule, as outlined on the Payment Page. With this enrollment, I release any and all rights and claims for damages against Music and My Child and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my enrollment at Music and My Child. I understand that make-up classes must be made up during the same semester and that refunds are not given after the first day of class. There are of course, special circumstances, such as a move out of the area, but these are dealt with on an individual basis.

Policies for Cash/Check Payments

You have my permission to email class-related information and announcements. I understand that my personal information will not be released to any third party, and is for the exclusive use of communication from Music and My Child. I understand that the deposit is non-refundable. I understand that tuition payments of $60 are due every 4 weeks during the session. I understand and agree to the payment schedule, as outlined on the Payment Page. With this enrollment, I release any and all rights and claims for damages against Music and My Child and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my enrollment at Music and My Child. I understand that make-up classes must be made up during the same semester and that refunds are not given after the first day of class. There are of course, special circumstances, such as a move out of the area, but these are dealt with on an individual basis.

Please review and agree to the policies above and payment schedule.*

I agree