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 - Summer Classes
Amy Bartholf - Program Director
4147 St. Clair, Racine  WI 53402
262-497-1355
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 Summer page SUMMER Class Schedule below:
Class Name:
Kindermusik Class Location (check):    _____ Racine    _____ Kenosha/Lakeview
Day: 1st Choice: 2nd Choice:
Time: 1st Choice: 2nd Choice:
Registration and Tuition Fee:                        M. Huck Scholarship Donation:                       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:
  • Tuition must be paid in FULL, unless arrangements are made with Ms. Amy - Kindermusik of Racine.
Classes will be filled on first-come basis.

KINDERMUSIK - THE PREMIER MUSIC PROGRAM FOR YOUNG CHILDREN