Kindermusik and Rain Forest Camps - Data Sheet

CHILD’S NAME_________________________________________________________

MOTHER’S NAME_______________________________________________________

FATHER’S NAME_______________________________________________________

ADDRESS_______________________________________________________________

________________________________________________________________________

CITY                                                      STATE                                                                                   ZIP

PHONE_________________________________________________________________

E MAIL ADDRESS: ______________________________________________________

CHILD’S BIRTHDATE___/___/___ ANY FOOD ALLERGIES? _________________

SIBLINGS’ NAMES AND AGES:

________________________________________________________________________

Please help us with marketing by letting us know how you heard about KINDERMUSIK at THE BURCH SCHOOL

____ Kindermusik Web Site

____ Burch School Web Site

____ Newspaper (Which:_________________________________________________)

____ Southwestern Bell Yellow Pages

____ Word of mouth (Who:______________________________________________)

____ Other: ___________________________________________________________

____________________________________________________________

BRING A FRIEND DISCOUNT:

($5 off tuition for every new family recruited to Kindermusik…up to four families for a total of $20 off)

I am new to the Burch School and was recruited by: _____________________________

________________________________________________________________________

I am returning to the Burch School and have recruited:___________________________

________________________________________________________________________