June 19, 2013
Summer 2013 Registration Form
  

 
Child's First Name*
Child's Last Name*
Birthdate*
Parent/Guardian*
Address*
City*
State*
Zip Code*
Home Phone*
Cell Phone*
Email*
Choose Class*
Policy Agreement*

I understand there are no refunds for missed classes.  My child's participation in the class is not guaranteed until full payment is received.  Full payment must be received two weeks prior to the start of class, after which there are no refunds. If class is cancelled due to low enrollment, I will receive a full refund.
 
Agree   
Media Release*
I grant permission for my child to be photographed or recorded by a representative of Music Time Learning Center. I release and relieve Music Time Learning Center from any responsibility or liability for any claims arising from the publication of reproduction of any photographs, interviews or videos in any news or other media.  Media may be used for promotional purposes and grant applications.
 
Yes   No   
Method of Payment*

PayPal   Check   Credit Card   

After you hit "Submit" you will be directed to our payment information page.  You will receive a confirmation of registration email from a Music Time representative.


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