25218 Grogan’s Park Drive, The Woodlands, TX 77380

Phone 281-367-0545 Fax 281-298-6944

Web: www.kindermusikofthewoodlands.com Email: info@kindermusikofthewoodlands.com

Enroll by fax, by phone, by mail or in person at our office

Registration Summer 2008

Please complete one form for EACH child you are enrolling.

Child’s Name_________________________________________ Male____ Female____

Date of Birth____________ Age June 1____ New Student?___ Returning Student?____

Special Needs? (Medical, Behavioral?)__________________________________________________

Parent Name(s)____________________________________________________________________

Email for relaying important class information. We do not distribute your address. (Please Print Legibly)

_________________________________________________________________________________

Address__________________________________________________________________________

City_______________________________________________________Zip____________________

Home Phone_____________________________ Cell Phone_______________________________

Mom’s Work______________________________ Dad’s Work______________________________

New Students only:

What things most influenced you to inquire about our classes? ____Saw Sign ____Kid’s Directory

____ Our Website ____Kindermusik International Website _____Woodlands Online Website

____Interfaith Phone Directory ____Other Phone Directory, which one?__________

____Newspaper Ad ____Flyers Where?______________________

____Friend/Who?________________________ ____Other /Explain_________________________

Check the Class for which this student is registering:

___Sign & Sing (6 mo.-3 yrs.) Day & Time ___________

___Village (Newborn-18 mo.) Day & Time_____________ Materials: Regular?____ Sibling?_____

___Our Time (1.5 –3.5 yrs.) Day & Time_____________ Materials: Regular?____ Sibling?_____

___Imagine That (3-5 yrs.) Day & Time_____________ Materials: Regular?_____ Sibling?_____

___Young Child (4.5-7 years) Day & Time___________ Materials: Regular?___ Sibling? ___

Check the Sessions for which this student is registering:

Kindermusik: ____Session 1 ____Session 2 ____Session 3

Sign & Sing: ____Session A ____Session B

Tuition/Materials Total $________

Early Birds! Register by May 10 & take $5 off materials fee -$_________

Pro-rated amount for late registrants -$_________ No Late Fee.

Grand Total $__________ Paid Today $__________ Balance $___________

___Full Materials & Tuition Payment paid by ___Check #__________ ____Credit Card ____Cash

___Additional sessions balance to be paid by ___Check #__________ ____ Credit Card ____Cash

Do not email your credit card information. This is not a secured website. Call us OR we will invoice you.

Credit Card #_________________________________________________ Expiration Date ___________

Name on Card_______________________________________

Credit Card Billing Address and Zip Code:__________________________________________________

___________________________________________________________________________________

Signature________________________________________________________ Date_________________

My Balance Due Option for additional sessions will be paid by:

___Attached post-dated check payable to Kindermusik of The Woodlands in the amount of $________

___dated July 3 for Kindermusik Session 2

___dated August 1 for Kindermusik Session 3

___dated July 11 for Sign & Sing Session B

___Automatic credit card charge on

____ Due Date July 3 for Session 2

____ Due Date August 1 for Session 3

Do not email your credit card information. This is a not a secured website. Call us or we will invoice you.

Type card: __________________Card #__________________________________________

Expiration Date __________________

Name on card___________________________________________________

Credit Card Billing Address and Zip Code_______________________________________________

________________________________________________________________________________

Please Read, Sign & Date

*If I am paying by credit card or debit card, I authorize Kindermusik of The Woodlands to charge the above indicated account on the

due dates specified.

*If I am paying by check and my check is returned for insufficient funds, I authorize Kindermusik of The Woodlands to collect a NSF

fee of $25 and a new check or cash for the amount owed.

*I understand that there are no refunds, except if there is insufficient enrollment for the class to make.

*I understand that I am making a commitment to the length of the session, and that missed classes may be made up only

by visiting other summer classes if one exists and provided the class size is not exceeded.

*Occasionally photos are taken of our students during class. I give permission to use photos of my children or myself in newspaper

articles, ads, in studio marketing materials, and on the studio website.

*I release any and all rights and claims for damages against Kindermusik of The Woodlands and its staff in the unlikely event of

injury sustained by myself or my child(ren) during the course of or as a result of this musical activity.

*I agree to pay any collection agency fees and late fees in the event that may account is delinquent.

*I agree to pay a late fee of $10 if my balance is paid after the Due Date for each session. (Late Registrants are not charged a

late fee). Kindermusik Due Dates: May 30, July 3, August 1. Sign & Sing Due Dates: May 30, July 11.

*I agree to give written notice should I need to withdraw from the session due to unusual circumstances and have a $15

withdrawal fee applied against the remaining tuition. I understand that Materials and Tuition are non-refundable. The remainder of

the tuition after withdrawal fee, down payment and tuition to the point where notice was given will be credited to my account for up

to 12 months.

____Parent Signature_____________________________________ Date_______________

Signature required for enrollment.

You may submit by fax, by phone, by mail, in person.

If you are registering over the phone, you also need to mail your signed registration form to complete registration.