Fall 2009 Registration Form

Child’s Name_____________________________________Nickname______________________

Child’s Birth date__________________________Child’s age                                     
Parent’s Name                             Siblings/Ages                                       

Address                                                                                              

Email address                                                                                        

Home Phone                             Cell/Work Phone                                     

Emergency Contact Name and Number

Are there any special circumstances about which I should be aware?


Class Preference (Please check.)

Our Time (18 mo. – 3 ½ years) $198 includes Home Materials, 12 weeks
     _____Wednesday 10:30 – 11:05 a.m.

Family Time (Birth – 5 yrs) 12 weeks  $205 first child/$90 2nd-3rd child no charge for siblings                   6 mo. and under at the start of class on September 14 includes Home Materials (one set)
     _____Wednesdays 9:30 – 10:05 a.m.

Villages (birth - 18 months)  7 weeks $98 (Oct. 7 - Nov. 18)
______Wednesdays 11:15 - 11:45 a.m.

Imagine That!! (3 ½ - 5 years)  $205 includes Home Materials, 12 weeks 
     ____Wednesdays 12:00 – 1:00 p.m.  snack provided

Kindermusik for the Young Child 15 weeks $225 inludes Home materials
     ______Mondays 12:00 - 1:00 p.m. snack provided 


A non-refundable registration fee ($70.00) is due at the time of registration to hold your child’s place in class and order materials. You may pay the full balance the first day of class or in two separate payments (due Oct. 14 and Nov. 14). Please ask about additional payment plans. I am looking forward to singing, dancing, learning and growing with you and your child!

We, the undersigned parents or guardian of ________________________do hereby certify to Barbra Laird that our child is in good health and is able physically to participate in the Kindermusik program. We do give said child permission to participate in Kindermusik. We recognize that children are occasionally hurt while engaged in play as well as movement activities of this type. We therefore specifically authorize Barbra Laird to take our child to the doctor or emergency room of the hospital in the event it should be necessary, and agree to pay any medical charges which may be incurred. We assume all risks applicable to our child’s participation in this activity. We hereby waive any and all claims against Barbra Laird, Sweet Songs Studio, the owners of the building, the organizers, sponsors or any of the supervisors appointed by the above if involved in this activity. We have read and agree to the Policies of Participation regarding tuition payment and understand everything we have read in this policy.
Signed: _____________________________________Date:_______________________



Barbra Laird, Kindermusik
1511 Dewitt Street
Durham NC  27705
Enroll online today!