Your Name *

First Name

Last Name

Mobile Phone *

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Other Caregivers Name (Spouse, Grandparent, Nanny, etc.)

First Name

Last Name

Student Name *

First Name

Last Name

Date of Birth *

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DD

YYYY

Check all that apply

You referred a new Kindermusik family to our program who enrolled. (Pay in-person to apply discount.)

You are enrolling siblings in the same class. Submit a separate registration for each child. (Pay in-person to apply discount.)

You are enrolling a sibling in different classes. Submit a separate registration for each child. (Pay in-person to apply discount.)

Medical condition/Allergies (you would like staff aware of)

You are redeeming a Gift Certificate

Payment Method *

Online - Debit/Credit card

In-Person - Cash/Check/Debit/Credit

Venmo @musicandmychild

Redeeming Gift Certificate

Payment Agreement *

Cash/Check/Venmo 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 $125/$160 are due week-1 of 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 (this includes exposure or contraction of COVID-19). 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. Credit Card 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 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 (this includes exposure or contraction of COVID-19). 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.

I agree