Jewish Music Appreciation
Registration Form |
| YES! I want to register for the Fall/Winter Semester. |
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Child's Full Name
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Child's Hebrew Name |
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| Child's Age |
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Child's D.O.B.
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Mother's Full Name
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Father's Full Name
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Address
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Apt.
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City, State, Zip
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City State Zip
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Home Phone
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Mother's Cell Phone
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Father's Cell Phone
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| Email |
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Facebook Name* |
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*To see updates on info and schedules. |
Is there any information concerning your child that is important for the directors?
(ex: asthma, food allergies)
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Do you give permission to use photographs of your child in print materials, on our website, emails and
facebook? Yes No |
How did you hear about us?
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| PAYMENT PLAN |
| My child will attend partial classes for $15 per class. |
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I understand that by submitting this form I am comitting to pay the above outlined fees.
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Name: Initials: Date:
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