Registration Form
Kindermusik Registration
Registration Form - Print and Mail
Child's Name: Date of Birth:
Parents' Names:
Address:
Phone: Email:
____ referred by another student. Name of referring student:
Class Choice (circle one) Village Our Time Imagine That! Young Child
If your schedule is flexible please indicate more than one time if available:
1st choice: Day: Time:
2nd choice: Day: Time:
3rd choice: Day: Time:
Class Fee:
Village
- all students (includes materials and tuition) $80
Our Time
- all students (includes materials and tuition) $150
Imagine That!
- new IT! student (backpack, materials, tuition) $150
- returning student (materials, tuition, No backpack) $145
Early Bird Discounts Still Apply : Register before June 7 to avoid $10 late registration fee
Total Due $ ________________
Please list any additional concerns including medical needs or allergies which may help in planning this class or call to discuss in detail
To reserve a space, mail registration with check payable to Karen Kane. I will confirm receipt by email. Welcome letters with with directions will confirm day and time by mail.
Kindermusik with Karen Kane
106 Apple Valley Circle
Clarks Summit PA 18411