One form for each child, please. Please complete ALL the information. Thank you.
New student?_______ or Returning student?_________ Has your address changed? __________
Child’s Name__________________________________Birthdate_________________Age June 1 _________
Mother’s Name______________________________________Home Phone______________________________
Father’s Name______________________________________Work Phone_______________________________
Address_________________________________________   Other Phone________________________________

City_______________________TX   Zip_____________ Email___________________________________
Person Bringing the Child to class if other than a parent_______________________________________
Relationship_______________________________Phone_______________
New Clients. What forms of advertising influenced you to come here? Kid’s Directory____ Our Website ____
Kindermusik International Website____ Newspaper, which one?________________ Flyers—where?_________
Phone Directory, which one? _________ Newsletters, which one?________________  Other_________________
Whom may we thank for referring you? PLEASE give name___________________________

The NON-REFUNDABLE Payment and this completed form reserve your place in a class.
Please check the class you are enrolling in and write in the class day and time and a 2nd choice if possible.
Village____       Our Time_____       Imagine That!_____        Musik Makers______
Day & Time: 1st choice__________________ 2nd Choice_____________________   Session(s) # __________
Regular Materials?_______  Sibling Materials?_______  No Materials Needed?________

Makeup Policy. Missed classes may be made up by visiting other classes, even in other summer sessions, space available.

Village Sibling Policy. It is best if siblings 1½ through 4 years do not attend a Village class so that the parent can focus on the

baby.  Any sibling attending the class must be enrolled in a Kindermusik class of his own age.
Our Time Sibling Policy. Sibling babies in baby carriers may attend an Our Time class of an enrolled sibling, provided they do not

disturb the class or participate in the class. If the baby is old enough to participate in the class, he needs to be enrolled in the

class. Any older sibling attending the Our Time class must be enrolled in a Kindermusik class of his own age.
Imagine That & Musik Makers Sibling Policy. Siblings are welcome during the last 10 minutes of class when the parents join us.
Name of attending sibling child_________________________ Age____________ Is this child enrolled in Kindermusik?______

REFUND POLICY.  There is a 30-day notice for cancellation of enrollment.  A $20 Withdrawal fee will be

applied to tuition.  Materials fees are NOT REFUNDABLE once ordered.  There are no refunds for tuition, but

credits may be given with 30-day notice with unforseen cause. 

Tuition: $____ Materials: $____ Tuition/Materials Discounts $_____  Total: $_____   Post-dated checks?_____

Cash, Checks, Visa, MasterCard, American Express, Discover and Debit Cards are accepted in Hall’s Family

Musik office. I understand the makeup policy and the sibling policy. I UNDERSTAND THAT MY MATERIALSFEES AND TUITION ARE NON-REFUNDABLE.  I understand that I am making a commitment to the length of the session.

Parent Signature_______________________________________________________Date___________________

FOR FAXES ONLY: Credit Card Number______________________________ Expiration Date _______--_______