Kindermusik
®
Imagine That! Class
Ages: 3½ to 5 years old
Registration Form
Cost:
$160 (materials included) for 16 weeks (45 minute classes)
Discounts are available.
Choose Class Location:
Choose_One
First_Christian_Church_1506_Dug_Gap_Road_Dalton
Choose Class Dates, Time, Semester:
Child's Name
:
*
Boy or Girl:
*
Choose One
Boy
Girl
Date of Birth:
*
Choose Month
January
February
March
April
May
June
July
August
September
October
November
December
Day:
Choose Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year:
Choose Year
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Name and ages of siblings
Sibling's Name:
Age:
Sibling's Name:
Age:
Sibling's Name:
Age:
Sibling's Name:
Age:
About Parents
Parent Name:
*
Parent Name:
Mailing Address:
*
City:
*
State:
*
Zip:
*
Home Phone:
*
Work Phone:
Cell Phone:
E-Mail Address:
*
Previous Kindermusik Classes?:
Yes
No
If yes, please list:
If new, how did you hear about this class?:
Do you know anyone who would like to hear about Kindermusik?
Their Name:
Phone:
Their Name:
Phone:
Tell me one benefit you would like for your child to derive from this semester in Kindermusik.
For a printable PDF version choose one below:
Imagine That!
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