2011/2012 Music Enrollment Form

Please complete the enrollment form and click the "Submit Enrollment" button at the bottom. Fields marked * are required.

*Student's Name    *DOB(mm/dd/yyyy)

*Street Address

*City   *State(XX)  *Zip    


*Home Phone (xxx-xxx-xxxx)

* Emergency Phone (xxx-xxx-xxxx)
Cell Phone (xxx-xxx-xxxx)
Work Phone (xxx-xxx-xxxx)
*Email Address
*Person Responsible for Payments
*How do you plan to pay?
 
Kindermusik
Village  
Our Time  
Imagine That  
     
Music Program-someone will contact you with available times
Piano Lessons  
Clarinet Lessons    
Beginning Voice Lessons    
     

     By submitting this form, I understand that there is potential for injury with participation in any sport, including classes at Katie’s Dance Studio; and, while at Katie’s Dance Studio, its owners, directors and teachers will make every reasonable effort to eliminate potential for injury, such injury may still occur.  I understand this risk and agree to hold Katie’s Dance Studio, its owners, directors and teachers harmless from any and all liability connected with any injury arising out of participation in classes at Katie’s Dance Studio.
     By submitting this form, I will abide by the policies and procedures described. I have read, understand and agree with the studio policies, procedures, fees and payment schedule.

* I have read and fully understand the above agreement.