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
Amy Bartholf - Program Director
4147 St. Clair, Racine  WI 53402
262-681-0778
Child's Name Application Date:
(check):     _____ Male      ______ Female Birth 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. Note! RecPlex - Pleasant Prairie, WI enrollees must indicate if you are a RecPlex member by circling YES or NO.

If you are a member, please insert your RecPlex Family ID #____________________________.

Class Name:
Kindermusik Class Location (check):  __ Racine    __ Kenosha  __ Franklin  __ New Berlin
Day: 1st Choice: 2nd Choice:
Time: 1st Choice: 2nd Choice:
Registration Fee: Tuition Fee: Total: $$
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 registration fee must accompany this form to ensure your child is enrolled into the Kindermusik Class.
  • Make checks payable to: Kindermusik of Racine.
  • Mail Registration/Tuition to: Kindermusik of Racine - 4147 St. Clair - Racine, WI 53402

Tuition Policy, please see the Kindermusik of Racine Web site for more details.
FOR RecPlex enrollees: Child care is available by calling RecPlex - Anne Hamby at (262) 925-6748. This service is free for RecPlex members, and a small fee for non-members. Non-members, if you choose to enroll in Child care, then the $15 Non-member registration fee will be waived. Please circle to indicate yes or no, if you are enrolling your child in the child care during the Kindermusik sessions...

    YES    or    NO

 
Classes will be filled on first-come basis.

KINDERMUSIK - THE PREMIER MUSIC PROGRAM FOR YOUNG CHILDREN