Registration Student's Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Age Grade in School as of Sept. 1 Father's Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Mother's Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Student's Medical Information Are there any medical problems, learning difficulties, allergies, etc. that we should know about? I Understand That... ~Once enrolled a time slot is reserved just for me. I am a fall session (4months) student and responsible for session tuition, regardless of whether I attend the lesson or not. ~Applicatioin fee in is not refundable since others may be turned away. ~My child's class may be videoed for training and educational purposes. Select * Tots N Time Music N Motion Pre Kids N Keys Kids N Keys Date: Responsible Party's Signature: Thank you!
