**** Please call 310-621-7232 for class space availability before sending check ****

MUSIC WONDERS KINDERMUSIK

Registration Form

Child’Äôs name:_________________________________________________________________________

(first) (middle) (last)

Age: ___________ years _________ months Birth Date: ________________________

Name of current school, nursery school, preschool, or day-care:____________________________

First names and ages of siblings:__________________________________________________________

Parents’Äô name:_____________________________________________________________________

Home phone: __________________________ Business phone: __________________________________

Email: ___________________________________________

Address: ______________________ City: ______________________ Zip code: ____________________

What music instruction/experiences has your child had, if any?_____________________________

Please describe any special needs (medical, developmental, behavioral) which your Kindermusik teacher should be aware of, if applicable:

__________________________________________________________________________________________

Emergency Information (Must Be Completed):
Please comment on any allergies, fear, etc. your child may have:

__________________________________________________________________________________________

Person Who May be Contacted in an Emergency:

Name:_____________________________ Relationship:_________________ phone/cell:___________________

Name:_____________________________ Relationship:_________________ phone/cell:___________________

Name:_____________________________ Relationship:_________________ phone/cell:___________________

__________________________________________________________________________________________

Kindermusik Village: birth - 18 mos. Mommy/Daddy & Me [8 weeks]	Kindermusik Our Time: 18 mos. - 3-1/2 years Mommy/Daddy & Me [15 weeks]	Kindermusik Imagine That: 3-1/2 - 5 years Parents attend last 10 - 15 minutes of the class [15 weeks]
Kindermusik for the Young Child: (year 1) 5 - 6 years Parents attend the last 10 - 15 minutes of the class [15 weeks]	Kindermusik for the Young Child: (year 2, 3, 4) 5 - 7 years Must have completed previous level Young Child To be scheduled Parents attend the last 10 - 15 minutes of the class [15 weeks]

**Classes offered with minimum of 3 children enrolled.

Enrollment is ongoing. Call for availability.

Classes will be filled on a first-come basis. Your child’Äôs name will be added to the roster upon receipt of complete registration form and a non-refundable deposit (which covers the cost of home materials): (Prices include tax & shipping)

$50 for Village
$70 for Our Time
$75 for Imagine That
$65-90 for Young Child (prices may vary each semester)

Enrollment fee for the semester is due the first class session:

$96 for Village
$180 for Our Time
$230 for Imagine That!
$280 for Young Child

Enrollment fee is not refundable for missed classes. No individual make up classes offered. Group make up

offered if entire class is rescheduled.

****Please call 310-621-7232 for class space availability before sending check****

** Please make checks payable to Music Wonders.

Emergency Waiver:
I, as the parent or Legal Guardian for the child designated on this form, hereby hold Music Wonders harmless for any and all damages, injuries or losses that may be sustained while in the care of Music Wonders.

Waiver signature: ________________________________________________date:______________

Terms of Registration:
I have read the Music Wonders flyer and/or web site and agree that I accept the registration, tuition and refund terms stated in the flyer. I also understand and accept that any photos or video taken during classes may be used by Music Wonders for educational, advertising, and/or promotional purposes.

Parent signature: ________________________________________________date:______________

Classes are held at: the Music Wonders Studio 3737 Torrance Blvd, Suite #104 Torrance, CA.

Music Wonders Director/Kindermusik Instructor:

Gretchen M. Axton, MT (Music Therapist)

(310) 621-7232

www.musicwonders.com