TheMusikNest
          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: __________________________________________________________

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 Gilman Village, The Plateau Club or Brighton Gardens should be made payable to 
The Musik Nest.

AUTHORIZATION AGREEMENT and REFUND POLICY.

100% refund less a $25.00 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 by the third week of class.

Summer session: Cancellations must be received by the first day of class in order to receive a refund (less materials).

Payment Type - Check___ Visa___ Master Card___

Credit Card #:_____________________________

Expiration Date: _________/___________

Signature:_________________________________

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 The Musik Nest. 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