Kindermusik - 8 week spring term

Benson School of Music - Kindermusik Registration (Levels 1 and 3 ONLY)

Registration for 8 Kindermusik classes from Saturday, April 11 - May 30
Student Name*

First NameLast Name
Student Birth Date*

MonthDayYear
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

CityState / Province

Postal / Zip Code
Main contact cell number (1)

Area CodePhone Number
Main contact cell number (2)

Area CodePhone Number
Is there anything we should know about you? (allergies, family needs, etc)
Please select your class time

Fees due upon registration (non-refundable)

Fees due upon registration (non refundable)$201.25CAD

$ 175 + tax (non refundable) - Price includes 8 weeks of Kindermusik Level 1 (ages 1-2 years) on Saturdays, 10:00am - OR - Kindermusik Level 3 (ages 3-5 years) on Saturdays, 12:00pm

Quantity

Total $0.00CAD

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

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.
Signature
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Benson School of Music - Kindermusik Registration (Levels 1 and 3 ONLY)