Acorn Kindermusik Registration

Registration Form
Summer 2001

Print this form, fill it out, make check payable to Celia Meehan, and mail the form with the check to:

Acorn Children's Music
632 Condor Avenue
Ben Lomond, CA 95005

Parent's Name:

Caregiver's Name (if participating in class):

Street Address:

City, State, Zip:

Home Phone:

Alternate Phone:

E-mail Address:

How did you hear about Acorn Kindermusik?

First Child's Name:

Second Child's Name:

New Registration? YES NO

Special or Medical Needs:

Birth Date:

Class Number:

Class Fee

Registration/Materials Deposit

Balance Due

A materials/registration deposit of $50.00 must be paid at the time of registration for all classes except Young Child classes which require a materials/registration deposit of $70.00. This fee is non-refundable after the first week of classes.
The balance of tuition is due on or before the first day of class. Payment schedules may be arranged with Teacher Celia.
There will be a $15.00 charge for returned checks.
Each Kindermusik program is a one- or two-year series of age-appropriate, exciting family music sessions. Each session requires the materials/class fees to be paid at registration times.
Classes will be filled on a first-come basis. Receipt of registration and fee will add your child's name to the class roster. If the class you have chosen is full, you will be contacted to arrange placement in another appropriate class or to place your child's name on a waiting list.

I have read the foregoing policies and signify my understanding of and agreement with them by signing and dating this registration form below.

Signature: ___________________________________________ Date: ________________

Printed Name: ________________________________________