Summer 2017 Registration Form Summer 2017 Registration Form Child #1 Name * First & Last Name Child #1 Birth Date * Child #1 Summer Camp Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #1 Second Choice (if my first is unavailable) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #1 Second Summer Camp (attending multiple camps this summer) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #1 Second Choice (if my first choice is unavailable) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #1 is... * brand new to Kindermusik returning returning after absence returning family, new sibling Child #2 Name First & Last Name Child #2 Birth Date * Child #2 Summer Camp * (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM #2 Second Class Choice (if my first choice is unavailable) (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #2 Second Summer Camp (attending multiple sessions this summer) (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM #2 Second Choice (if my first choice is unavailable) (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #2 is... * brand new to Kindermusik returning returning after absence returning family, new sibling Child #3 Name First & Last Name Child #3 Birth Date * Child #3 Summer Camp (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #3 Second Choice (if my first choice is unavailable) (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 9:00AM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #3 Second Summer Camp (attending multiple sessions this summer) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #3 Second Choice (if my first choice is unavailable) (Blank) Dew Drops: June Tuesdays 9:15AM Dew Drops: June Tuesdays 5:15PM Dew Drops: July Tuesdays 11:00AM Dew Drops: July Wednesdays 5:00PM (Blank) Beach Days: June Tuesdays 9:15AM Beach Days: June Tuesdays 10:15AM Beach Days: June Tuesdays 11:15 AM Beach Days: June Tuesdays 6:15 PM Creatures at the Ocean: July Tuesday 10:00AM Creatures at the Ocean: July Wednesdays 6:00PM (Blank) On the Road: June Tuesdays 10:15AM On the Road: June Tuesdays 6:15PM Rock & Roar: July Tuesdays 11:00AM (Blank) Musical Theatre RATS!: June 5-9 1:00PM Musical Theatre RATS!: July 31-Aug 4 9:00AM Intro to Bucket Band: July Tuesdays 6:15PM Bucket Band: July Tuesdays 5:45PM Child #3 is... * brand new to Kindermusik returning returning after absence returning family, new sibling Contact Information Parent Name * First & Last Name Parent Name First & Last Name Address * Street Street Line 2 City State Zip Phone Number * Alternate Phone Number Email Address * Caregiver Name (if attending class with child) First & Last Name Do any of the children you are registering have special needs? Please explain. Referred to Music Connections by: Payment Preferences Tuition Payment Method * Cash or Check Credit Card Responsibility * I understand that it is my responsibility to keep my credit card information up to date. Any delays in current information may result in payments beyond nine months or doubled charges in order for my account to remain current. Type of Credit Card * Visa Mastercard American Express Discover Credit Card Number (must be provided to process payments) * Expiration Date * Month / Year Security Code (on back of card) * Card Holder's Name * As it appears on the card Card Holder's Address * Street Street Line 2 City State Zip Repeat Enrollment Check here if you are enrolling siblings in the same class. Photo Permission * You have my permission to use photographs or video of my child from class for occasional promotional postings (no last names used). Total Number of Children You are Registering? * 1 2 3 Non Refundable Registration Fee Due Now (You will be directed to a page where you can securely pay with a credit card or Paypal) $ reCAPTCHA If you are human, leave this field blank.