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 from the options below.

Materials' costs are included in Semester Fees

Newborn to 18 Months

Birth - 7 Years

Begins July 5, 2011

Begins July 5 & 6, 2011

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...

CREDIT CARD INFORMATION

Your payment will be processed only when your space in the class of your choice is confirmed.

WE ACCEPT VISA, MASTERCARD, DISCOVER CARD & AMERICAN EXPRESS.

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

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

*First Names & Ages of Siblings:

*Required field

5-week session fees: $95

Summer Camp Online Registration Form

with

Claudia

Arlington, Texas 817-478-3550

18 Months to 3.5 Years

Begins July 5, 2011

5-week session fees: $95