Hoja De Registro

Registration Form

Student Information

First Name ________________________ Last Name_____________________

Date of Birth ______________ Details we need to be aware __________________________

Postal Address _________________________________________________________________

Contact Number:_________________________ Email ________________________________

Name of Mother :_________________________ Name of Father________________________

Is any other adult sharing class with your child? ____I yes, Name ________________

Course Information

Course ________________ Day ___________ Time ____________

Start Date ______________ Duration of Class _______

# of Classes per session ______

Teacher's name ____________________________

*NO CLASS ON FOLLOWING DATE:

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Cost of course (materials, taxes & tuition included)

Total: $____________- discount (when apply) ___________ =______________

____ Cash

____ Check: Please make check Payable to: Yessenia Torruellas

____ Online-Easy Enroll Credit Card payment

____ PAID

*PAYMENT MUST BE MADE IN FULL PRIOR TO FIRST DAY OF CLASS. WE CAN'T RESERVE A SPACE UNTIL PAID IN FULL.

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How did you hear about us

_________________________________________

Please initial each item and sign and date at the bottom

____ I understand and agree that if I must cancel my registration, I have to do it written prior to this date: ____________________ to get 50% of the total refunded. 50% is non-refundable.

____ I understand and agree that if my child misses class, he will be able to attend (1) one makeup class per semester. Date, time and type for make-up class will be selected by

____ I read, fully understand and agree with ALL class policies.

Liability Waiver

As parent or guardian of __________________________________________

I certify that I and my enrolled child listed above, are physically able to participate in the Kindermusik program at ____________________________. In the unlikely event of an accident or injury sustained by myself, my children or assigned caregivers during or as a result of, our participation in Kindermusik classes, or any other activity at ____________________ I assume all liability and waive any and all claims

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