Kindermusik by Creative Kids

PLEASE COMPLETE THE FOLLOWING INFORMATION
Child's Name:
Date of Birth:
Name(s) of Parents/Caregiver:
Address:
Postcode:
Home Phone:
Work Phone:
Mobile:
Email:
Preschool/School(if enrolled):
Grade:
If new, how did you hear about Kindermusik?:
Time and day of class attending:
Please describe any health issues, learning difficulties, or disabilities:

Please nominate the Kindermusik class/classes you have chosen:
	Kindermusik Village (0 - 18mths)
	Kindermusik Our Time (18mths - 3yrs)
	Imagine That (3 yrs - 5yrs)
	Kindermusik for the Young Child 1,2,3 or 4 (4yrs - 6yrs)
	Family Time (0-5yrs)

LOCATION	DAY	TIME	TERM FEE	MATERIAL FEE



TOTALS

If you have any special material requirements i.e. you already have a bag/instrument/or siblings materials etc, please list below:


Method of Payment
	Money order
	Cheque (made payable to Jacqui Blackeby)
	Cash
	Direct Debit BSB: 035 039 ACC: 207180 Name: Jacqueline Blackeby (please include your child's surname in the reference details)

* After submitting this form you will receive a summary of the details you provided above. You will then receive a second email from us informing you that we have processed your child's details, and that payment is required before your child is enrolled. If you do not receive this second email then please contact us via email or phone notifying us of this.

Click Submit to send.

CONTACT US - 8364 2356 or email contact@kindermusikbycreativekids.com.au