Please fill out a separate form for each child participating

Fields marked with an * are required

Class Name *

—Please choose an option—Watch Me Grow - Ages 0-36 monthsFamily Music for Toddlers - Ages 15 months - 3 ½ yearsAll Together Now - Ages infant - 5 yearsToddler/Pre-K - Ages 1.5 years - 6 yearsCycle of Seasons - Ages 3 - 5 years

Day of Week/Time *

Session Dates *

Child's First Name *

Child's Last Name *

Child's Age at Start of Class

Years *

Months *

—Please choose an option—01234567891011

Gender *

—Please choose an option—MaleFemale

Medical conditions pertinent to class (if applicable)

Parent Name (first and last) *

Best Phone *

Parent Name (first and last)

Best Phone

Address *

City *

State *

Zip *

Best Email Address *

Is this your first time participating in a Musikgarten class?

—Please choose an option—YesNo

Will a caregiver, other than Mom or Dad be bringing the child to class?

—Please choose an option—YesNo

If yes, please specify:

First and Last Name of Caregiver (if applicable)

Relationship to Child

Please check the box for all that apply:

I am registering multiple children of the same household - 10% discount for second child and every child after that.

I registered upon referral from a family who has participated in a Signature Music Musikgarten class - $12 off your registration and the next registration of the person who referred you (please specify below)

Name of person who referred you (if applicable)

* I, the registrant, have reviewed the Policy and Procedures document, and by submitting my registration I agree to comply with the policies set forth in the document.