| Class Day and Time: | |
| Class Location: | |
| Adults: First and Last Names | |
| Parent or Caregiver Attending
Class: (add caregiver's phone if different) |
|
| Child #1 Name and D.O.B. | |
| Child #2 Name and D.O.B. | |
| Child #3 Name and D.O.B. | |
| Street Address: | |
| City, State, Zip | |
| Home Phone: | |
| Emergency Phone (spouse, friend, etc.) | |
| Email Address: | |
| Amount Enclosed and Check # Don't forget to add $10 reg. fee if this is your first class at Music Together of Milford (child classes only) |
|
|
How did you hear about this program? (newspaper, friend,
flyer... please be as specific as possible, thanks!) |
Mail this form and check made out to:
Music Together of Milford, 102 Elm Street, Milford, NH 03055.