Miss Roberta's Music Together

Below is a form you can fill out to register for one of our classes.

Tuition is $195 for the 1st child and $135 for the 2nd child. The registration fee for returning families is $5. The registration fee for new families is $10. Tuition includes 2 CDs, a songbook, and activity suggestions for parents. Refunds are not available after the second class, but 2 make-ups can be arranged based on availability.

We will confirm your registration one week prior to the beginning of the session. Payment is due at the beginning of the first class.

Make Checks payable to: MISS ROBERTA'S MUSIC TOGETHER

Your First Name:*
Your Last Name:*
Street Address (including apt. number):*
City:*
State/Province:*
Zip/Postal Code:*
Home Phone:*
Work Phone:
Mobile Phone:
Email:*	Contact Preference:

Registrants

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Registrant #1

Registrant #2

Registrant #3

Class 1^st Choice

Location:	Class Type:

Class:*
<Select Location and Class Type first>

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.

Location:	Class Type:

Class:
<Select Location and Class Type first>

* - required fields.

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Registrants

Class 1st Choice

Class 2nd Choice — Please select a second class in case your first choice is unavailable.

Class 1^st Choice

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.