1) Please Choose 1st and 2nd Choice for class times.
The schedule below is all the class times that I can teach,
however, all class times may not fill so please select two class times.

2) Print registration form below

3) Registration forms must  accompany the deposit which is listed
below and is NON-REFUNDABLE.

Please mail forms to me at 1107 9th Street Mukilteo, WA. 98275.
Make checks  payable to Bodge Music Academy.

4) There is a discount for families with children enrolled in the same class,
please ask to find out if you qualify.

5) Classes Begin January 28, 2009 and all classes are 15 weeks in length
Calendars are available in the studio on first day of class.
 

Child's Name: ____________________________________  Date of Birth: ________________

Name(s) of Parents: ___________________________________________________________

Address: ____________________________________  City___________________________Zip: _______________________

Home Phone w/Area Code: _________________________  Work Phone w/Area Code: ___________________________

Email Address: _______________________________

Health Concerns/Food Allergies?_________________________________________________________________________

Are there any medical or behavioral problems I need to be aware of?_____________________________________________________________________________________________________

How did you find out about Kindermusik:  Mailing_____Demo Class____Story Hour_____800 #_________________
 
 

VISA____  Mastercard_____  Name on Account_______________________________________________________
Account number___________________________________________Exp Date_________________________________
Signature_________________________________________________
Check number____________________________________________Amount___________________

In registering my child for_______________________________, I agree to pay $______________ for the semester.
Enclosed is the $_________________registration fee to hold my space in class.  I understand that the registration
fee is non-refundable, and that the tuition is due two weeks prior to the first day of class.  I have read the studio policy,
I understand it, and agree to abide by the rules and regulations.
Parent Signature: ___________________________________

Printed Name:  _____________________________________

Date: ______________________

Please make check payable to: Bodge Music Academy or Jessica Bodge  (not Kindermusik)  and mail with print-out of this Registration Form to: