Parents names:

Child's name:

2nd child or 2nd session:

E-mail:

Street address:

Session:

Class level:

Session:

Class level:

City, state, zip:

1st choice code:

Class day/time:

1st choice code:

Class day/time:

Home phone:

Work phone:

2nd choice code:

Class day/time:

2nd choice code:

Class day/time:

cell or pager:

Emergency contact person:

Materials fee:

Registration fee:$10.00 after Aug. 15

Materials fee:

Total amount due: ____________ (Please make check out to: Sonoma County Children's Music)

Credit Card#_____________________________________________________(VISA or MC only)

Expiration date _____________ Name on Card ______________________________________

Please send enrollments via: email (frano@pacbell.net), Fax (527-7900), or U.S. Mail (see below)

There is a $15.00 charge on all returned checks and a $25.00 cancellation fee after Aug. 15. There are no cancellations/refunds after the first week of classes except in emergencies & at the discretion of SCCM. While we make every effort to provide a child safe environment, you are responsible for supervising your child while on the premises or in a class together. SCCM & it's employees are not liable for any injury on or near the premises. On occasion we take photographs in class for educational or promotional purposes. Your registration confers agreement to all aforementioned fees and policies. Please sign below.

I have read and agree to all fees and policies of SCCM______________________________________________

Sonoma County Children's Music
867 3rd St. Santa Rosa, Ca. 95404
(707) 527-7900
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