Kindermusik Registration Form

Student Information
First Name:  
Middle:
Last Name:  
Birthday: / / (mm/dd/yyyy)
Age at start of semester:  

Gender:

Status:

Address:

 
City:  
State:  
Zip:  

Parent/Guardian Name(s):

 
Email address:  
Home phone:  
Cell or Work phone:

Course/Tuition Information
Class:  
Preferred date and time (first choice):
Preferred date and time (second choice):

Tuition:

$
Discount if applicable: $ (10% discount for second 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.