Jewish Music Appreciation
Registration Form
YES! I want to register for the Fall/Winter Semester.
Child's Full Name   Child's Hebrew Name
Child's Age   Child's D.O.B.
Mother's Full Name   Father's Full Name
Address   Apt.
City, State, Zip
City State Zip
  Home Phone
Mother's Cell Phone   Father's Cell Phone
Email   Facebook Name*
      *To see updates on info and schedules.
Is there any information concerning your child that is important for the directors?
(ex: asthma, food allergies)
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?
My child will attend partial classes for $15 per class.
I understand that by submitting this form I am comitting to pay the above outlined fees.
Name: Initials: Date: