CROSS OF CHRIST
            Kindermusik Registration

Please COMPLETE & MAIL this form with your payment.

CHILD'S NAME: ___________________________________________________________

PARENTS' NAME (S) : ______________________________________________________

ADDRESS: ________________________________________________________________

CITY: _______________________________ ZIP CODE: ___________________________

HOME PHONE: ____________________ BUSINESS PHONE: ______________________

EMERGENCY NAME AND TEL: ______________________________________________

EMAIL ADDRESS: __________________________________________________________

CHILD'S NICKNAME: _________________________ BIRTH DATE: _________________

DOES YOUR CHILD HAVE ANY SPECIAL PHYSICAL OR LEARNING NEEDS OF
WHICH I SHOULD BE AWARE? ______________________________________________

HOW DID YOU FIND OUT ABOUT KINDERMUSIK? (Please be specific if possible. A 
friend, a particular advertisement, 800 number)_______________________________________

Please fill out every class for which you wish to register. For example, if you would like Creatures at the Ocean and Creatures in My Backyard, include them both.

KINDERMUSIK CLASS: _________________________________________________

DAY:______________________________ TIME: ______________________________

CLASS DATES: ____________________________ CLASS FEE: __________________

KINDERMUSIK CLASS: __________________________________________________

DAY: _____________________________ TIME: _______________________________

CLASS DATES: ____________________________ CLASS FEE: __________________

Tuition is payable in full and is due upon registration. Please register early in order to allow adequate time for student materials to be ordered. Checks for Kindermusik classes at Cross of Christ should be made payable to Cross of Christ.

AUTHORIZATION AGREEMENT and REFUND POLICY.

100% refund less a $10.00 processing fee: if your request to withdraw is received a minimum of 7 business days prior to the first of class.

Pro-rated refund of tuition (less materials): If your request to withdraw is received the first week of class.

I agree to pay a $15.00 fee in the event that the bank due to non-sufficient funds does not honor my check.

I understand that I have registered ____________________________ for a Kindermusik class at Cross of Christ Church. 
A spot in the class has been reserved for my child for the duration of the class. I have read and agree to the above refund policy.

_______________________________________
Parent/Guardian Signature

_____________________
Date

RETURN FORM TO:
TheMusikNest
PMB# 379
16625 Redmond Way Suite M
Redmond, WA 98052