Registration Form
Registration Form
Tots and Toddlers Music Time for children 18 mos to less than 4 years
Class time: Tuesdays
Dates: 10 weeks beginning 2/9/2010. Snow and make up days April 20 and 27
Cost: $100 (includes tuition and instrument) + $10 registration fee for new students
Location: Scout Room at the Waverly Community House (www.waverlycomm.org)
Child’s Name: Date of Birth:________
Parents Names:_____________________________________________
Address:____________________________________________
___________________________________________________
Phone: Email _____________________________
How did you hear about it?
Class Time Choice: 1st Choice:________ 2nd Choice _________ can do either _____
On the back please list any additional concerns including medical needs or allergies which may help in planning this class or call to discuss these in details.
KidsMusic with Karen Kane
www.kidsmusicwithkarenkane.orbitaltec.net
email: karen@kidsmusicwithkarenkane.orbitaltec.net
(570) 586-1051
Release: I/we do not, will not hold any individual associated with KidsMusic, the
Waverly Community House or Board of Trustees, volunteers or
Parent/Guardian Signature:____________________________________
Registration is closed when class maximum is reached.
Enrollments will be confirmed in the order that registrations are received.
To reserve a space, print and mail this signed registration form with check payable to
Karen Kane.
Mailing Address: