Class Enrolment Form
Fill out for class enrolment and access to Kindermusik Home Materials
Primary Parent/carer
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Second parent/carer
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
First Child:
First Name
Middle Name
Last Name
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
MALE
FEMALE
NOT SPECIFIED
Second Child:
First Name
Last Name
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
MALE
FEMALE
NOT SPECIFIED
Class you are enrolling in (tick choice)
Kindermusik TUESDAYS 11am ($14 per class)
Kindermusik SATURDAYS 10.50 am ($14 per class)
Drumming - SATURDAYS 9.15am (TBC)
Are there any medical, behavioural or other needs that may impact your child's participation in the class?
I give permission for Kindermusik with Melanie Jane to send occassional newsletters or emails containing promotional and other information (2 to 4 times per year)
YES
NO
Payment options
prev
next
( X )
Kindermusik class - TERM 3
$70.00 AUD
$
70.00
AUD
Number of weeks paid
5
6
7
8
9
10
Item subtotal:
$0.00 AUD
$
0.00
AUD
Kindermusik class - FIRST-TIMER OFFER (3 classes)
$28.00 AUD
$
28.00
AUD
Kindermusik - SINGLE CLASS
$14.00 AUD
$
14.00
AUD
EFT Payment : BSB 633000, Account no.146393806, Account name: M McIntosh. PRICES as above
Free
$
Free
AUD
Total
$0.00 AUD
$
0.00
AUD
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