--------------------REGISTRATION FORM--------------
Parents name(s)_____________________________
(Please include caregiver's name if they will be participating in class)
___________________________________________________________________
Mailing Address____________________________________
(street or p.o. box)
___________________________________________
(city)
(state) (zip)
Home phone__________________ Work or Cell _____________
Child's name_______________________ Date of Birth ________
Age___________ How did you hear about us?_______________
Session: ABC MUSIC &
ME WIGGLE & GROW
ABC MUSIC & ME LAUGH & PLAY
OUR TIME
IMAGINE THAT!
FAMILY TIME
Day/Time of Class_____________________________________
First name and ages of siblings___________________________
Please include any additional information about you or your child that will help me best meet your needs:____________________
____________________________________________________
____________________________________________________
YOUR ENROLLMENT WILL BE CONFIRMED WITH A WELCOME LETTER AND/OR PHONE CALL WITHIN TWO WEEKS.