Children’s Music and Movement 12-week Fall 2021 Session
Registration is limited. To register for Pre-K please email Kenya Jackson at klawrence@sttimothyumc.org
Student's Name
*
First Name
Last Name
Parent's Name(s)
First Name
Last Name
Student Age
Birthdate
-
Month
-
Day
Year
Date
Grade
K
1
2
3
4
5
6
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
School Attending
Emergency Contact
Does Child Play an Instrument
Piano
Violin
Guitar
Bass
Drums
None
Has your child participated in Children's Music and Movement before?
Yes
No
Can Parent Volunteer
Yes
No
Submit
Should be Empty: