2022 Summer ECE registration form

Early Childhood Education

Summer 2022 Class Enrollment Form
Each enrolled child should have an accompanying adult to participate with them in the class. It is suggested that, whenever possible, the same adult participate each week. If you have questions about the class please call our office 203 227 9474

All classes will be held at the WESTPORT CAMPUS
Suzuki Music Schools, 246 Post Road East, Lower Level, Westport CT 06880 (entrance and parking in the rear, accessible from Post Rd. or Imperial Ave.)

Everyone ages 2 and up are currently required to wear a face mask inside the school.
Child's Name *

First Name Last Name
Gender *
Date of Birth *

Month Day Year
Name of participating adult *
FAMILY STATUS

Currently enrolled family Returning alumni family NEW family
Parent's Name *

First Name Last Name
Parent's Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
WEEKLY CLASSES

Westport Summer 2022

Saturdays, July 9th - August 20th (7 weeks)

Minimum: 4

Jump Start: 1-4 years, 40 minutes, ongoing (enroll anytime)

Meet the Instruments: K-1, 40 minutes, 7 weeks, summer only

________________________________________________

Available Fall 2022

Early Start: birth to 12 months, 40 minutes, ongoing

Jump Start: 1-4 years, 40 minutes, ongoing (enroll anytime)

Ready Start: 4-6 years, 40 minutes, 17 week semester offered fall or spring

I would like to enroll my child in (please note class time and location) *

product

JUMP START: Saturdays, Westport @ 9:00 $ 238.00

Start July 9

product

MEET THE INSTRUMENTS: Saturdays, Westport @ 10:00 $ 238.00

Start July 9

Enter coupon

Total $ 0.00

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

Photo Permission

I give permission for my child's likeness to be used in print, video, or electronic media. (Names will not be used.)
Should be Empty: