Print and mail this file back to me or click the enrollment button below to register electronically.
The Music Meri FALL 2011 REGISTRATION FORM
Class Locations are all at
St. Paul's Lutheran Preschool
1250
East. Heim Ave.
Orange, CA 92865
Please make checks
payable to:
The
Music Meri P.O. Box 4064 Orange, CA 92863-4064
Online payment with a
credit card is also available through www.musicmeri.com!
Questions?Contact Mary Dahlia at (714) 403-4711 or email at: musicmeri@earthlink.net
www.musicmeri.com
REGISTRATION
FORM: Fall 2011
Please fill out in entirety. Email will only be used to contact you with
regards to class information and will only be used by me. I do not share this with anyone else – Thanks!
PARENT INFORMATION
* Parent
Name:_______________________________________________________________________
Address:___________________________________________________________________________
City:
_____________________________________State:_______________ Zip:_________________
Home Phone:
___________________________________
Work Phone:
___________________________________
Cell Phone:
____________________________________
Email Address:
______________________________________________________________________
Emergency Contact:
__________________________________________________________________
Emergency Phone:
______________________________
How did you hear about us?
___________________________________________________________
Referred by:
________________________________________________________________________
THIS SECTION MUST BE FILLED OUT
CHILD INFORMATION – 1 CHILD
INFORMATION – 2
Child Name:
______________________________________ Child Name:
___________________________________
Child DOB:
_______________________________________ Child DOB:
____________________________________
Desired Class/Day/Time:_____________________________
Desired
Class/Day/Time:__________________________
Alternate
Class:____________________________________ Alternate
Class:__________________________________
CHILD INFORMATION
– 3 CHILD
INFORMATION - 4
Child Name: ______________________________________ Child Name:
___________________________________
Child
DOB: _______________________________________ Child DOB:
____________________________________
Desired
Class/Day/Time:_____________________________ Desired
Class/Day/Time:__________________________
Alternate Class:
____________________________________ Alternate
Class:__________________________________
