Kindermusik with Carla

Registration Form Fall 2017
To enroll, please complete, print, then mail this registration form with you check made payable to:
Kindermusik with Carla, 250 E Philadelphia Ave, Bridgeport, WV 26330
Fall 2017
Sept 7 - Dec 20, 2017

Click here for our
Courtesy Information

Village
Total Classes 14
Class Length 45 min.
Total Cost
Includes tuition
and materials
$208
Adult in attendence

Our Time
Total Classes 14
Class Length 45 min.
Total Cost
Includes tuition
and materials
$208
Adult in attendence

Imagine That!
Total Classes 14
Class Length 45 min.
Total Cost
Includes tuition
and materials
$208
Adult attends last 10 min.

Young Child
Total Classes 14
Class Length 60 min.
Total Cost
Includes tuition
and materials
$254
Adult attends last 10 min.

Parent/Guardian:
Mailing Address:
City/Zip:
Phone:
Work or Cell Phone:
e-mail:
New to Program Previously Enrolled

How have you heard
about us?

1st Child's Name:
Date of Birth/Age:
Program:
Day/Time Preferred:

2nd Child's Name:
Date of Birth/Age:
Program:
Day/Time (1st Choice):
Day/Time (2nd Choice):

Payment Plans
Payment in full

Payment Method
Payment by check (payable to Kindermusik with Carla)
Payment with credit card: Visa or MasterCard
Cardholder Name:
Credit Card Number:
3 Digit Sercurity Code:
Exp. Date:
Billing Address:
City & Zip Code:

I am enrolling my child for the entire fall semester of Kindermusik and understand that my
non-refundable payment(s) is due accordingly.
Signed:
Thank you for choosing Kindermusik!


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Kindermusik with Carla
250 E. Philadelphia Ave • Bridgeport WV 26330
304.848.2848
loghome98@aol.com

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