Child’s Name_______________________________________________  Male_____ Female____

Date of Birth ______________Age Sept. 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.

__________________________________________________ 

Home Phone____________________________  Cell Phone______________________________
Address______________________________________________
City___________________________________   Zip______________
New Students only: 

How did you learn about us? Check all that apply.  ___Online search ___ Our Website ___Kindermusik Intn'l Website 

____Kid’s Directory ____Interfaith Phone Directory  ____Saw Street Sign  _____Saw Car Sign

____Newspaper Ad  ____Flyers/where?________________  Friend/who?_________________________

Sign & Sing (6 mo.-3 years)___  Day & Time__________   Materials?________________

Village (Newborn-18 mo.)____  Day & Time__________  Regular Materials?____  Sibling Materials?_____

Our Time (18 months-3.5 years)____  Day & Time__________  Regular Materials?____  Sibling Materials?_____

Imagine That (3-5 years)____  Day & Time_________  Backpack/new IT student____  Regular Mats?_____ Sibling ?_____

Young Child (4.5-7 years) Yr 1___  Yr 2____  Day & Time____________  Regular Materials?____  Sibling Materials?____ 

Special Order Materials_________________________________________

Tuition/Materials Total   $_______   

   Early Birds! Register and pay full tuition by August 1st and save $10  -$______

   Register more than one child & take $10 off each additional child after the first one at regular price   -$_____

   Pro-rated amount for late registrants   -$_____   No Late Fee

Grand Total  $_____  Paid Today  $_____  Balance $_____ DUE SEPTEMBER 5.   Late Fee $15 after Sept. 12.

unless you have set up a payment plan with post-dated checks or credit card charges on Oct. 10 & Nov. 7.

____Down Payment OR ____Full Payment paid by ____Check#_____ OR   ___Credit Card OR   ___Cash

My Balance Due Option will be paid by:

____Attached post-dated check for the balance, dated ___Aug. 1 for Early Bird Discount, or ___the due date Sep. 5 OR

____Attached 2 post-dated checks, each for half the balance dated Oct. 10 and Nov. 7 OR

____Automatic credit card charge for the balance on ___Early Bird Discount Date, Aug. 1 or _____Due Date Sep. 5 OR

____Automatic credit card charges for half the balance each on Oct. 10 and Nov. 7.

Credit Card#______________________________________  Expiration Date__________________

Name on Card_________________________________  Credit Card billing address same as home address?____ 

If different, give full address________________________________________________________

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

NSFfee of $30 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 semester, and that missed classes may be made up only by

visiting other fall 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 my account is delinquent.

*I agree to pay a late fee of $15 if my balance is paid after September 12. (Late Registrants are not charged a late fee.)

*I agree to give written notice should I need to withdraw from the semester due to unusual circumstances.  I agree to have a

$25 withdrawal fee applied against the remaining tuition.  I understand the Down Payment is forfeited.  The remainder of the

tuition after the 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_______________