Fall 2011, REGISTRATION SHEET

(Please print this sheet, complete one sheet per child, and return the sheets to the Burch School)

Please enroll my child in following Kindermusik Class at the Burch School of Music:

(if you are available for more than one section, please indicate 1^st, 2^nd, 3^rd choices)

____ Village/Feathers & Do-Si-Do (0 – 1.5 yrs.) Wednesdays from 8:30-9:15 a.m.

____ Our Time/Wiggles and Giggles (1.5 – 3 yrs.) on Tuesdays from 9:00-9:45 a.m.

____ Our Time/Wiggles and Giggles (1.5 – 3 yrs.) on Wednesdays from 9:45-10:30 p.m.

____ Our Time/Wiggles and Giggles (1.5 – 3 yrs.) on Fridays from 9:00-9:45 a.m.

____ Imagine That!/See What I Saw (3 – 4 yrs.) on Tuesdays from 1:15-2:00 p.m.

____ Imagine That!/See What I Saw (3 – 4 yrs.) on Fridays from 10:15 a.m.-11:00 a.m.

____ Young Child Semester I (4 – 7 yrs.) on Mondays from 4:15- 5:15 p.m.

____ Young Child Semester I (4 – 7 yrs.) on Wednesdays from 2:00-3:00 p.m.

____ Young Child Semester III (4 – 7 yrs.) on Thursdays 2:45-3:45 p.m.

____ Young Child Semester III (4 – 7 yrs.) on Thursdays 4:00-5:00 p.m.

Classes must have at least five students in order to be offered. Other times may be available upon request, so please let me know if your child has conflicts with these times and needs a different schedule.

YES! I wish to enroll my child for the entire academic year. S/he will be enrolled in the following class in the Spring semester:

 __________________________ for a total tuition cost of $____________

__________________________________________________________________________________________________________________________________

Signature of Parent or Guardian                                                        Phone                                                                     Date

CHILD’S NAME_________________________________________________________

PARENTS’ NAMES ______________________________________________________

ADDRESS_______________________________________________________________

________________________________________________________________________

CITY STATE ZIP

PHONE_________________________________________________________________

E MAIL ADDRESS: ______________________________________________________

CHILD’S BIRTH DATE__/__/__ FOOD ALLERGIES: _________________________

How can we help your child with any other special needs? _______________________

________________________________________________________________________

SIBLINGS’ NAMES AND AGES:___________________________________________

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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: ___________________________________________________________

____________________________________________________________

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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:___________________________

________________________________________________________________________

Please return this page, plus tuition check by August 15 to: