Music Together Form

* Indicates required field

Your name *

First

Last

Relationship to Child *

Name/Relationship of grownup attending class (if different) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number to text if class is cancelled due to weather or sickness *

If you would like an additional person, such as a nanny, texted as well, please put their number here *

Email to send registration info *

If you would like an additional person, such as a nanny, emailed this info, please put their email here *

Participating Child's Name (Nickname) & Birthdate *

Participating sibling(s) (nicknames) & Birthdate(s), if applicable *

Would you like a CD? Tuition cost is the same, with or without the cd. *

Yes No

Would you be interested in purchasing a djembe drum? (Rhythm Kids families) *

Anything special you would like me to know? *

Have you previously taken Music Together with Lakeside Music (Ms. Kat)? *

Yes No

Have you previously taken music together or another group music class? *

Yes No

How did you hear about us? *

Waiver *

I agree.