Child #1

First Name*: Middle Name: Last Name*: Age*: Birth Date (MM/DD/YYYY)*:

Parent/Class Partner #1:

Parent/Guardian's Name*:

Child #2

First Name:
Middle Name: Last Name: Age: Birth Date (MM/DD/YYYY):

Parent/Class Partner #2:

Parent/Guardian's Name:

Street Address*:
City*: State*: ZIP Code*:
Best Contact Phone*:
E-mail*:

Registration Information:

Desired Class Time*: ---Fall 2015: Thursdays 10:00-11:00 AMSpring 2016: Thursdays 10:00-11:00 AMAll Other Times FULL

Registration/Materials Fee*: ---1 Student: $502 Students: $903 Students: $120

Class Tuition*: ---1 Student -Fall Semester: $2202 Students -Fall Semester: $440

If Prorated Term, How Many Weeks?: ---987654321

Payment Method*: Check ---Cash ---

I herby agree to abide by the “Dallas Baby Music Class Policies and Procedures in their entirety.”

Electronic Signature:

Parent/Guardian's Name*: Today's Date (MM/DD/YYYY)*:

You will be sent a copy of this registration information to the email address you provided. Please mail or bring your registration and tuition payments to:

Dallas Baby Music Classes
11882 Greenville Avenue
Suite B103
Dallas, TX 75243
Phone: 214-269-8545
www.DallasBabyMusic.com

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