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Parent/Guardian Contact Information
First Name:
Last Name:
Local Address*:
Address Line 2:
City*:
State/Province*:
Zip/Postal Code:
Country*:
Local Home/Cell Phone
(with area code)*:
Work Number (with area
code):
Parent/Guardian Email*:
Confirm Email:
Relationship:
CHILD
#1 -
Child #1 First Name*:
Child # 1 Last Name*:
Year of Birth* (yyyy):
CHILD
#2 -
Child #2 First Name*:
Child #2 Last Name*:
Year of Birth*:
CHILD
#3 -
Child #3 First Name*:
Child #3 Last Name*:
Year of Birth*:
I grant permission for
my child (children) to take the following
class(es) with VSM *.
Course Registration
Information
Please register the
above named child(ren) for the following class(es):
(Select the desired classes by highlighting
the button to the left of the class name.)
Music Discovery for
Kids - Thursdays
at Midpark Assembly
(starts January 14th, 2010 at 6:30pm)
Time: 6:30pm - 7:30 pm
ONLINE PRICE:
$70.00 /per child (6 classes)
Special Notes: Limited enrollment.
Grades 1 - 6.
Music Discovery for
Kids - Thursdays
at Midpark Assembly
(starts March 4th, 2010 at 6:30pm)
Time: 9:15am - 10:15am
ONLINE PRICE:
$70.00 /per child (6 classes)
Special Notes: Limited enrollment.
Grades 1 - 6.
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