Registration Form Fall 2010
To enroll please read our courtesy information and registration guidelines. Complete this form and
mail to: Kindermusik Northwest, 117 S. Cook St, PMB #327, Barrington, IL 60010,
fax to: 847-304-8963 or call 847-304-8947 to register by phone.

Beginning July 1st you can also register by phone, 847-304-8947 or fax, 847-304-8963
Fall 2010
Classes begins
Tuesday Sept 7th

Click here for our
registration guidlines
Village
Total Classes 14
Class Length 45 min.
Materials $75
Tuition $180
Adult in attendance
Our Time
Wiggles & Giggles
Total Classes 14
Class Length 35 min.
Materials $60
Tuition $180
Adult in attendance
Imagine That!
Hello Weather!
Total Classes 14
Class Length 45 min.
Materials $60
Tuition $180
Adult attends last 10 min.
Young Child I or II
Total Classes 14
Class Length 60 min.
Materials $75
Tuition $200
Adult attends last 5 min.
Kids n' Musik Choir
Total Classes 14
Class Length 75 min.
Materials $50
Tuition $220
**Special Notes…

**Sibling Kits are available for Our Time, Imagine That! and Young Child levels of the program. If you are registering more than one child in the same level or have had an older child in that level - This reduces your fee.

**$10 Sibling discount is given to every child after the highest tuition is paid in full.

**There are many concurrent class offerings if you have more than one child.

**The entire price for a class is Materials+Tuition

**Receive $25 off tuition for every new family you refer to Kindermusik Northwest!

A $75 nonrefundable deposit per child is due at time of registration. The deposit will be applied to your total fee.
Parent/Guardian:
Mailing Address:
City/Zip:
Home Phone:
Work Phone:
Cell Phone:
e-mail:
Who can we thank for referring you to Kindermusik Northwest?”
1st Child's Name:
Birthday & Age by 9/1:
Day/Time (1st Choice):
Day/Time (2nd Choice):
Day/Time (3rd Choice):
Material Option:
 Full Materials Sibling Kit No Materials*
*Only available for families who have previously had this semester.
Pertinent Information (medical or otherwise):

2nd Child's Name:
Birthday & Age by 9/1:
Day/Time (1st Choice):
Day/Time (2nd Choice):
Day/Time (3rd Choice):
Material Option:
 Full Materials Sibling Kit No Materials*
*Only available for families who have previously had this semester.
Pertinent Information (medical or otherwise):
For payment we accept Visa, MasterCard, Money Order or Personal Checks
Cardholder Name:
Credit Card Number:
Exp. Date:
Please check one of the following
Apply my deposit only to this card
Apply my deposit to this card now and my balance due after 08/10/09

I, _________________________________________________ (please sign) hereby authorize Kindermusik Northwest to apply the total tuition and materials fee (less any applicable discounts) to my credit card.

I release any and all rights and claims for damages against Kindermusik northwest and it's Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of this musical activity.

Sign Here:
Payment in full is due if registering after August 11th.