Registration Form Spring 2010

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
Spring 2010
Feb. 1 - May 21, 2010

Click here for our
Courtesy Information
Village
Total Classes 15
Class Length 45 min.
Total Cost
Includes tuition
and materials		 $193
Adult in attendence
Our Time
Total Classes 15
Class Length 45 min.
Total Cost
Includes tuition
and materials		 $193
Adult in attendence
Imagine That!
Total Classes 15
Class Length 45 min.
Total Cost
Includes tuition
and materials		 $193
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?
1st Child's Name:
Date of Birth/Age:
Program:
Day/Time Preferred:

2nd 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, $54 by Feb. 15 & $54 by Mar. 15
Young Child
$95 at registration, $75 by Feb. 15 & $75 by Mar. 15
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 spring semester of Kindermusik and understand that my non-refundable payment(s) is due accordingly.
Signed:
Thank you for choosing Kindermusik!

Close