Kindermusik with Suzie - Registration Form

To complete this form, please print out and
mail to the address located at the bottom.

For best results, use our printer friendly version.
(Will open in a separate window).

Child Name(s):	______________________________________________

Address:	______________________________________________
	______________________________________________
	______________________________________________

Age(s):	_______________________

Birthday(s):	_______________________

Parent/Guardian Full Name(s):	______________________________________________

Home Phone:	_______________________

Work Phone:	_______________________

E-mail:	__________________________________

Class Name/ Section:	1st Choice:	__________	2nd Choice:	__________	3rd Choice:	__________

Day:	1st Choice:	__________	2nd Choice:	__________	3rd Choice:	__________

Time:	1st Choice:	__________	2nd Choice:	__________	3rd Choice:	__________

This fee includes both tuition and home materials; it is non-refundable and must accompany this form. This fee is due before the first day of class. Teacher absences will be made up. If scheduling permits, student absences can be made up. If your check is returned to me due to insufficient funds or for any other reason, there will be a $20 fee.

Sibling Discount: Take 10% off each additional child's fee. The 10% discount will be applied to the lower priced class.

Referral Bonus Program: Earn $10 for each person referred who has registered and paid. Please indicate on this form/contact me if you are referring someone.

Customer Loyalty & Reward Program: Pay in full for 2 sessions (excluding summer) and receive $10 off the third session.

Gift Certificates are available! Give the gift of music!

Signature:	___________________________________________

Date:	____________________

Please make the check or money order payable to: Suzie Kramer

Registration form and check or money order should be mailed to...

Suzie Kramer
67 Rear Bridge Street
Beverly, MA 01915