Kindermusik Registration Form




Student Information

First Name: 
Middle/Maiden Name: 
Last Name: 
Birthday: 
Age at start of semester:  
Gender:
Status:
Address: 
City: 
State:                Zip: 
Parent/Guardian Name(s): 
Email Address: 
Home Phone: 
CellPhone: 

Course/Tuition Information

Class: 
Preferred date and time (first choice): 
Preferred date and time (second choice): 
Tuition:  $
Discount if Applicable:  $

(10% discount for sedcond tuition in a family in the same semester)

Total:  $

At least half of the total amount is due at registration. You will be billed for the remaining amount. Checks are payable to Lebanon Valley College.