Benson School of Music - Kindermusik Registration
Registration for Kindermusik classes Level 1 (ages 1-2 years) , Level 2 (ages 2-3 years), and Level 3 (ages 3-5 years)
Student Name
*
First Name
Last Name
Student Birth Date
*
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Year
Main contact name(s)
Main contact email address (1)
example@example.com
Main contact email address (2)
example@example.com
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main contact cell number (1)
-
Area Code
Phone Number
Main contact cell number (2)
-
Area Code
Phone Number
Choose your preferred class level and class day/time. NOTE: LEVEL 1 and LEVEL 3 classes are all currently FULL ,
*
LEVEL 1 (ages 1-2 years): SATURDAYS at 9:00am with Miss Elizabeth
LEVEL 1 (ages 1-2 years): SATURDAYS at 10:00am with Miss Elizabeth
WAITLIST ONLY: LEVEL 2 (ages 2-3 years): SATURDAYS at 11:00am with Miss Melody *class is currently full*
WAITLIST ONLY: LEVEL 3 (ages 3-5 years): SATURDAYS at 12:00pm with Miss Chloe *class is currently full*
Is there anything we should know about you? (allergies, family needs, etc)
Were you referred to our program by a BSoM family? If so, please name here
I acknowledge that by providing my electronic signature, I realize that photos or video may be taken in class for the use of educational and promotional purposes. I understand that if my preference is to NOT have photos/videos shared on social media, I must email jenniferbensonmusic@gmail.com to notify our office.
I acknowledge that I have read and agree to the Benson School of Music Studio Policies
Fees due upon registration (non-refundable)
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Kindermusik Registration Fee
$
25.00
CAD
Non refundable. Registration fee for Kindermusik classes.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
CAD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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