Registration Form Centennial Park

Registration Form

Music and Movement for Kids and Caregivers
Who: Preschool children ages 2-5 with an accompanying adult/legal guardian

When: Fridays, 11:00 - 11:30am

Schedule: 8-Week Session: January 9 - February 27, 2026

Where: Centennial Park Recreation Center (1120 Centennial Boulevard, Port Charlotte, FL 33953)

Cost: $50 for entire 8-week session, due at the first class via Check, Cash, Venmo or Zelle.
Child's Full Name

First NameLast Name
Child's Birthday

MonthDayYear
Date
Child's Favorite Song/Type of Music
Is there any other important information pertaining to your child's participation in music and movement that you would like the instructor to know?
Full Name of Parent/Legal Guardian who will accompany child

First NameLast Name
Parent/Legal Guardian Phone Number
Please enter a valid phone number.
Parent/Legal Guardian Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
GUIDELINES FOR PARTICIPATION
- A parent/legal guardian MUST accompany and remain with the child for the entirety of each class.
- Children and caregivers must wear closed-toe shoes to ensure safety while moving and playing instruments. Children should wear clothes that enable comfortable movement.
- Participants are permitted to arrive at the facility no earlier than 10:45am prior to the start of class.
I attest that I have read all guidelines for participation in Music and Movement for Kids and Caregivers and I agree to provide payment in full at the first class of the session. I agree to accompany my child to all classes.
Signature

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Date of Signature

MonthDayYear
Date
Upon selecting Submit, you will be redirected to the Liability Waiver, which must be signed in order to complete registration.
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Registration Form

GUIDELINES FOR PARTICIPATION

I attest that I have read all guidelines for participation in Music and Movement for Kids and Caregivers and I agree to provide payment in full at the first class of the session. I agree to accompany my child to all classes.