Initial Kindermusik Class Enrolment Form

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

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
Date Date Picker Icon
Gender

MALE FEMALE NOT SPECIFIED
Second Child:

First Name Last Name
Birth Date

Month Day Year
Date Date Picker Icon
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

Kindermusik class - TERM 3 $ 135.00 AUD

Number of weeks paid
Item subtotal: $ 0.00 AUD

Kindermusik class - FIRST-TIMER OFFER (3 classes) $ 28.00 AUD

Kindermusik - SINGLE CLASS $ 14.00 AUD

EFT Payment : BSB 633000, Account no.146393806, Account name: M McIntosh. PRICES as above Free

Total $ 0.00 AUD

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