Kindermusik with Claudia

*Child's First Name:

*Child's Last Name:

*Child's Birthdate:

*Parents' First Names:

*Parents' Last Name: Name:

*Address:

*City:

*Zip Code:

*Home Phone:

*Cell Phone:

Work Phone:

*Email Address:

Father's Occupation:

Mother's Occupation:

What formal music instruction has the child had (if any)?

Musical training of parents: Lessons / Instruments / Voice / Your interest:

How did you hear about Kindermusik with Claudia?

*Are there medical or behavioral conditions or food allergies of which the instructor

should be aware?

Press ENTER only when you are ready to submit the form.

If you wish to register more than one child, please use a separate form for each child.

Please select the class in which you would like to register your child.

Materials' costs are included in Semester Fees.

Newborn to 18 Months

18 Months to 3.5 Years

Begins Feb 7, 2012

Begins Feb 7, 8, & 9, 2012

PAYMENT METHOD

You may pay by personal check or by credit card.

If you are paying by personal check, please make it payable to:

Kindermusik with Claudia

Please mail check to:

Claudia Spinney

P. O. Box 170432

Arlington, TX 76003-0432

You may reach Ms. Claudia with your credit card payment information at:

817-478-3550

Please do not leave your credit card information on the voicemail...

...if unavailable at the time, Ms. Claudia will contact you.

To complete the registration process, please click the "Submit Registration Form" button.

3.5 to 5 Years

Begins Feb 8, 2012

*First Names & Ages of Siblings:

*Required field

Semester fees: $220

Semester fees: $230

Online Registration Form

with

Claudia

Newborn to 7 Years

Begins Feb 7 & Feb 9, 2012

Semester fees:

$70 First Child

$75 Second Child

$45 Each Additional Child

Arlington, Texas 817-478-3550