Press the "Submit Registration Form" button at the bottom of the page only when you are ready to submit the form. Use TAB and SHIFT-TAB to navigate from field to field. If you wish to register more than one child, please use a separate form for each child.
Child's First Name:
Child's Last Name:
Child's Birthdate:
First Names & Ages of Siblings:
Parent's First Names:
Parent's Last Name:
Address:
City:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Father's Occupation:
Mother's Occupation:
What formal music instruction has the child had (if any)?
Musical training of parents: Lessons / Instruments / Voice / Your interest:
How did you hear about Kindermusik by Sheila?
Are there medical or behavioral problems or food allergies the instructor should be aware of?
Please select the class you wish to register your child for.
All prices include materials.
Newborn to 18 Months
18 Months to 3 Years
3 to 5 Years
YEAR ONE
5 to 7 Years
Sesssion 1: 1/26-4/5
Session 2: 4/5-5/24
Each session: $130
Both sessions: $245
Begins Jan. 26, 2012
15 week semester fees: $245
Begins Jan. 24, 2012
15 week semester fees: $255
Begins Jan. 23, 2012
15 week semester fees: $285
Thursdays 11:30--12:15 am
PAYMENT METHOD
You may pay by personal check or by credit card.
We take Visa, Mastercard, Discover & American Express .
If you are paying by personal check, please make it payable to
"Kindermusik by Sheila" and mail it to:
Sheila Pruehs
1035 S. Helena St.
Colton, CA 92324
Paying by Credit Card:
Once I receive your form submission, I will email you an invoice where you can instantly pay by credit card online through a secure server (through PayPal). You do NOT need to sign up for a PayPal account to do so.
I will reserve your child's place in the class as soon as I receive payment.
