| Course First Choice: |
|
| Course Second Choice: |
|
| Mother's Name: |
(first and last name) |
| Father's Name: |
(first and last name) |
| Caregiver's Name: |
(if attending) |
| (1) Child's Name: |
(first and last name) |
| (1) Child's Date of Birth: |
(mm/dd/yy) |
| (2) Child's Name: |
(first and last name) |
| (2) Child's Date of Birth: |
(mm/dd/yy) |
| (3) Child's Name: |
(first and last name) |
| (3) Child's Date of Birth: |
(mm/dd/yy) |
| Address: |
|
| City: |
|
| State: |
|
| Zip Code: |
|
| Phone: |
|
| E-Mail: |
|
| Emergency Contact Name: |
|
| Emergency Contact Phone: |
|
| Fee Calculation |
|---|
| First Child |
$125 |
| Sibling over 9 months |
$75 each
|
| Sibling under 9 months |
"Free Rider" |
| One time family registration fee |
$25 - This applies only if this is your family's first registration to Music Together of Union County |
| Total: |
|
|
