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KINDERMUSIK DATA SHEET

 

CHILD’S NAME: _________________________________________________
PARENTS’ NAMES: _________________________________________________
ADDRESS: _________________________________________________
______________________________________________________

City

State

Zip

PHONE: _____________________________________________________________

Home

Cell

Work

E MAIL ADDRESS: _________________________________________________
CHILD’S BIRTHDATE __/__/__ FOOD ALLERGIES: _______________________
SIBLINGS’ NAMES AND AGES: _________________________________________

If your child has special needs, please let us know. We would like to serve you and your family to the best of our abilities, and it is very important to understand the children we teach. This information would be held in strictest confidence: __________

______________________________________________________________________________________

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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

____ The Schoolhouse

____ 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:___________________________

________________________________________________________________________

 

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Dr. Holly Hughes, Director       The Burch School of Music
          
P.O. Box 2345                Weatherford, Texas 76086

For more information, please call Dr. Hughes at 817-341-2345 (metro)
or send email to HollyHughes@burchschool.com

       © 2008 Software Solutions of Weatherford       Revised April 4, 2009