Your Name *

First Name

Last Name

Other Caregiver Name (Spouse, Grandparent, Nanny, etc.)

First Name

Last Name

Phone *

(###)

###

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Student Name *

First Name

Last Name

2nd Sibling Name

(if applicable)

First Name

Last Name

3rd Sibling Name

(if applicable)

First Name

Last Name

Payment Method *

Online - Debit/credit card

Venmo @musicandmychild

In-person - Cash/check/card

Payment Agreement (Cash, check, credit card, or Venmo) *

Cash/Check/Venmo Payments You have my permission to email class-related information and announcements. I understand that my personal information will not be released to any third party, and is for the exclusive use of communication from Music and My Child. I understand that the deposit is non-refundable. I understand that tuition payment is due prior to the class. With this enrollment, I release any and all rights and claims for damages against Music and My Child and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my enrollment at Music and My Child. I understand that refunds are not given. Credit Card Payments You have my permission to email class-related information and announcements. I understand that my personal information will not be released to any third party, and is for the exclusive use of communication from Music and My Child. I hereby authorize Music and My Child to apply the fees (less any discounts) to my credit card. I understand that a deposit is non-refundable and will be charged to my account along with tuition payment. I understand and agree to the payment schedule, as outlined on the Payment Page. With this enrollment, I release any and all rights and claims for damages against Music and My Child and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my enrollment at Music and My Child. I understand that refunds are not given.

I agree