Registration Form

FALL 2008 Registration
(form available in pdf/jpg format if you email your request)

Student Name:________________________________________ Date of Birth:______________

Student Name:________________________________________ Date of Birth:______________

Parent/Guardian Name(s)______________________________________________________

Phone Numbers: Day____________________________ Evening________________________

Mailing Address:_________________________________________________________________

Email Address____________________________________________________________________

Any medical conditions of note:__________________________________________________

Please choose class for enrollment:
Family Music Tuesday: 9:30-10:15 ______
Music Readiness Tuesday: 10:30-11:15_____
Music Readiness Tuesday: 1:00-1:45_____

I understand that participation and consistency is very important to the success of the learning process and enjoyment of the child and the adult. As a participant, I agree to respect start times, to stay the whole class time and to be responsible for my child inside the studio and in the waiting room. If my child appears to be ill, I will not attend class. I will not wear street shoes in the studio. Barefeet, socks, slippers or dance shoes are permitted.
I have read, understand and agree with the policies listed on Policies page.

I assume all risks and responsibilities and release the S.P.A.C.E and teachers from any and all liability.

Signature ________________________________________________Date___________________

Office Use:

Class enrolled:
Amount ($169):
15% sibling discount:
Total amount: