Registration for Spring 2021 Zoom Classes
Music Classes for Children Ages 3-5
Every Other Friday @ 2:30 Pacific Time
Jan. 29, Feb.12, 26, March 12, 26, April 9, 23, May 7, 12, June 4
Parent Name
*
First Name
Last Name
Child(ren) Name(s)
*
First Child
Second Child
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Today's Date
*
-
Month
-
Day
Year
Date
Signature
*
Please verify that you are human
*
Photo/Video Waiver
*
I give my consent for photos and videos of me and my child(ren) to be used for educational and promotional purposes by Molly White Music.
Suggested Amount
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( X )
USD
$20 for 2 classes, or $15 to drop-in.
Comments
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Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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