Kindermusik of Racine

Registration Form  (If registering for more than one child, please print out additional forms and staple together. Thank-you for your cooperation.)

Kindermusik of Racine - North Prairie
Amy Bartholf - Program Director
602 Prairie View Drive
 North Prairie, WI 53153
262-497-1355
Child's NameApplication Date:
(check):     _____ Male      ______ FemaleBirth Date:
(check): Yes ___ No ___ Re-enrolling family address and phone on file. Indicate any changes below.
Parent(s) or Guardian(s):
Address:
City:State:Zip:
Home Phone:Work Phone:
Email Address:
Emergency Contact (if different from above):
Child's Health/Other: List any medical or behavioral conditions of which the Instructor should be aware of:

 

First Name and ages of siblings:

 

 

 

 

 

 

 

        Please fill-in the Class information from the Kindermusik Website Class Schedule below:

Class Name: Kindermusik Music Box
Kindermusik Class Location (check):_____ A NEW BEGINNING PRESCHOOL
Day:1st Choice:2nd Choice:
Time:1st Choice:2nd Choice:
Registration Fee:Tuition Fee:
Parent/Guardian Signature:

Your signature is required above. I agree to the terms/conditions to the registration, tuition fee schedule and the tuition policy as outlined on this registration form AND I do hereby release and forever discharge Amy Bartholf, Kindermusik of Racine, her studio, the studio teachers, and owners of any facilities where she teaches, from any and all actions, claims and demands for, upon or by reason of damage, loss of personal injury which may be sustained by my child, myself, spouse and/or a family member during the course of or as a result of this musical activity.

The $50 registration fee must accompany this form to ensure your child is enrolled into the Kindermusik Class.
  • Make checks payable to: Kindermusik of Racine.
  • You can drop off the registration form at A NEW BEGINNING PRESCHOOL - 129 Harrison Street - North Prairie, WI in the "Music Box" drop-box.
  • Or, mail to the address above.

Tuition Policy:

  • Tuition must be paid in FULL by FIRST DAY of class. Unless arrangements are made with Ms. Amy - Kindermusik of Racine.
  • There will be no tuition refunds after week 4.
  • There will be no registration fee refunds.
  • Sibling discount is $20 if 2 or more children are enrolled.
Classes will be filled on first-come basis.

KINDERMUSIK - THE PREMIER MUSIC PROGRAM FOR YOUNG CHILDREN