Kindermusik with Carla

Registration Form Fall 2011
To enroll, please complete, print, then mail this registration form with you check made payable to:
Kindermusik with Carla, 250 E Philadelphia Ave, Bridgeport, WV 26330

Fall 2011 Sept 13 - Jan12, 2012 Click here for our Courtesy Information
Village
Total Classes	15
Class Length	45 min.
Total Cost Includes tuition and materials	$197
Adult in attendence

Our Time
Total Classes	15
Class Length	45 min.
Total Cost Includes tuition and materials	$197
Adult in attendence

Imagine That!
Total Classes	15
Class Length	45 min.
Total Cost Includes tuition and materials	$197
Adult attends last 10 min.

Young Child
Total Classes	15
Class Length	60 min.
Total Cost Includes tuition and materials	$245
Adult attends last 10 min.

Parent/Guardian:

Mailing Address:

City/Zip:

Phone:

Work or Cell Phone:

e-mail:

New to Program Previously Enrolled

How have you heard
about us?

1^stChild's Name:

Date of Birth/Age:

Program:

Day/Time Preferred:

2^nd Child's Name:

Date of Birth/Age:

Program:

Day/Time (1st Choice):

Day/Time (2nd Choice):

Payment Plans

Payment in full

Pay in installments:
Village, Our Time & Imagine That!
$85 at registration, $56 by Oct. 1
& $56 by Nov. 1
Young Child
$95 at registration, $75 by Oct. 1
& $75 by Nov. 1

Payment Method

Payment by check (payable to Kindermusik with Carla)

Payment with credit card: Visa or MasterCard

Cardholder Name:

Credit Card Number:

Exp. Date:

Billing Address:

City & Zip Code:

I am enrolling my child for the entire fall semester of Kindermusik and understand that my non-refundable payment(s) is due accordingly.

Signed:

Thank you for choosing Kindermusik!


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