Rhythm Kids Fall Registration Form

Rhythm Kids Registration

For ages 4-8 • September 11-November 14 • Mondays at 4:00-4:45pm
Child's Name #1 *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
School *
Child's Name #2 (if applicable)

First Name Last Name
Birth Date

Month Day Year
Gender
Parent/Caregiver Name *

First Name Last Name
Parent E-mail *
example@example.com
Mobile Number *
Nanny/Caregiver Name (if applicable)

First Name Last Name
Nanny/Caregiver Phone
Please enter a valid phone number.
Who will be bringing your child to class and what is their relationship to the child? *
How did you hear about us? *

I've taken classes at Mattix Music before. Friends Teacher Social Media KidList Other

Tuition & Djembe Drum Rental

Tuition Tuition per family

$ 265.00

Djembe Drum Rental Djembe drums are required for class. Rent a djembe from us for $20.00 per semester. Client will be charged a $65.00 replacement fee if the drum is damaged, lost or stolen.

$ 20.00 Quantity

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signed by *

First Name Last Name
Signature *

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Rhythm Kids Registration