Music Together Spring Registration Form
Returning families only fill out the * parts or if anything has changed from this/last session
*Parent's First and Last Name: ______
Email: ______
Mailing Address: ______
City: ______Zip ______
Best Phone #:______Other Phone # (optional)______
1st Registered Child's name (first last) 1st Child's Birth date (mm/dd/yy)
______
2nd Registered Child's name (first last) 2nd Child's Birth date (mm/dd/yy)
______
3rd Registered Child's name (first last) 3rd Child's Birth date (mm/dd/yy)
______
Do you have an infant sibling, less than 9 months old (on the first day of class) that will attend class for free with an older paying sibling?
____ Yes ____ No Name of Infant Sibling ______
Spring 2014 10 Week Session, April 5 – June 16
Urbandale – Mon 6:00 PM, Fri 9:30 and 10:30 AM
Clive – Tu 10:00 AM, Wed 10:00 AM, Th 6:00 PM, Sa 9:45 AM
Des Moines – Mon 10:00 AM
Ankeny – Tu 10:00 AM, Wed 10:00 AM, Th 5:25 and 6:20 PM, Sa 9:45 AM
*Please choose your three choices:
*1st Choice Class-Day and Time: ______
*2nd Choice Class-Day and Time: ______
*3rd Choice Class-Day and Time: ______
Cost:
$170.00 for one child, $300.00 for two, if paying prior to 3/2.
$180.00 for one child, $320.00 for two, if paying after 3/2.
You may pay by Credit Card online (click the blue button toward the top of the first page) or by calling (515)457-8834 or mail this form with a check to: Songs and Signs, 1020 Cedar Circle., West Des Moines, IA 50266.
Your cost and priority on getting your 1st Choice is contingent on when payment is received.
Please read the following and indicate your agreement by checking the "Yes" and signing.
I agree to assume responsibility for my child or children and myself and/or caregiver when upon the premises of achurch or other location for a class with Songs and Signs, LLC., and will hold harmless Songs and Signs, LLC and any of its employees and/or agents in the event of any personal injury, property damage or loss, indemnifying said parties of any loss that I might incur as a result.
I have read and understand the above policy:_____Yes
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Signature of Parent or Guardian