Press ENTER 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.
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 and send to me at the address below:
Kindermusik by Sheila
1035 S. Helena St.
Colton, CA 92324
If you are paying by check, or prefer to call in credit card information, you have completed the registration process. Scroll down and click the grey "Submit Registration Form" button.
CREDIT CARD INFORMATION
Your payment will be processed only when your space in the class of your choice is confirmed.
WE ACCEPT VISA, MASTERCARD & DISCOVER CARD & AMERICAN EXPRESS.
Credit Card Number:
Expiration Date
Month:
Year:
Name on Credit Card:
Billing Address of Credit Card:
City, State & Zip:
Apt. #:
Please enter your billing information (as it appears on your credit card statement).
