Music Together with Ann Quinn - Registration Step 1

Fill in the form and print

Class session 1st Choice 2nd Choice
Day: Time: Day: Time:

Parent Names(s):
Attending caregiver name:
Attending caregiver relation:
Address:

City:

State:

ZipCode:

Parent Home Phone: Work phone:

e-mail address:

Please include name and birthday of all children attending class, including
non-paying siblings.

Child 1:

Sex:

DOB:

Child 2:

Sex:

DOB:

Child 3:

Sex:

DOB:

Class fee for 1st child and parent
Class fee for each additional child
Siblings under 9 months old

$ 168
$ 110
Free

Tuition is due with application. No refunds after the second class.

Print this form and return it with a check payable to:
Ann Quinn Music Together
110 N Beechwood Ave
Catonsville, MD 21228
or (after printing) fill out credit card information and send to same address

VISA__ MASTERCARD__	AMOUNT
CARD NUMBER	CODE*
SIGNATURE	EXP DATE

*usually the 3 digit number at the end of the signiture line.

Then go to Next Step >

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