Naomi's Music - Registration for Fall 2010

Make-ups are encouraged and available during every scheduled class.

If you cannot make up a class and need to prorate (up to 2 classes), please use coupon code MISS1 or MISS2.

For more information about Kiddie Korner, check out their website: http://www.kiddiekorner.org/

* Your First Name:
* Your Last Name:
*Mailing Address:
*City:
*State/Province:
*Zip:
*Phone:
Other Phone:	Type (work, cell, etc):
*Email:	Contact Preference:
*Name of Accompanying Adult:	Prorating? Missed Class Dates:

Registrants

	First Name	Last Name	Date of Birth (mm/dd/yy)
Child #1
Child #2
Child #3

Class 1^st Choice

Location:	Class Type:

*Class:
<Select Location and Class Type first>

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.

Location:	Class Type:

Class:
<Select Location and Class Type first>

Waitlist OK?
YesNo

Comments:

How did you hear about us:

* - Required information.

Class 1st Choice

Class 2nd Choice — Please select a second class in case your first choice is unavailable.

Class 1^st Choice

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.