Registration Form

NAME OF CHILD
DATE OF BIRTH
PARENT/GUARDIAN’S NAME
ADDRESS
POSTAL CODE
HOME TELEPHONE
MOBILE TELEPHONE
E-MAIL
DAY OF FIRST CLASS
TIME OF CLASS
Preferred Day/Time for future consideration	Mon am/pm Tues am/pm Wed am/pm Thurs am/pm Fri am/pm Sat am/pm

Health concerns/medical conditions/other comments:
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How did you hear about Kindermusik?
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I wish to enrol my child _____________________________into Kindermusik® Village / Our Time / Imagine That / Young Child / Family Time (delete as appropriate) classes at ____________________________________, York.

SIGNED __________________________________DATE___________
(All personal records are strictly confidential)

Please make cheques payable to ‘Cath Smithson’ and return together with this completed form to: 13 Queen Anne’s Road, Bootham, York, YO30 7AA