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Special Class Registration

 

Please call 916-554-7658 or send an email to info@musicandmychild.com with any questions and we will be happy to assist you.

Contact Information
Name *
Name
Phone *
Phone
How did you hear about us?
Student Information
Student Name *
Student Name
2nd Sibling Name
2nd Sibling Name
(if applicable)
(if applicable)
3rd Sibling Name
3rd Sibling Name
(if applicable)
(if applicable)
Class Day and Time
Payment Policy (Cash, check, or credit card) *
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.