Movin' and Groovin' Registration Form

Summer 2009
Registration Form

Ages 0-7

Enrollment is Quick & Easy! (If you prefer to use a printable, mailable form, please use one of these links: Waunakee or Fitchburg.) Class availability is limited. Filled on a first-come, first-served basis. Minimum of 4 children needed to form a class. Please indicate your 1st, 2nd, and 3rd choices if possible. Summer class dates: Each session is 5 weeks long with 45-minute weekly classes. Whole family participation, with up to 3 siblings per family. Waunakee: July 27 - August 28 $69 reserves your place and purchases your home materials. Only one registration fee per family. Home Materials include: 2 Jelly Bean Band books with activity pages, comic strips about the band, and stories; 2 Jelly Bean Band puppets; 2 Monkey den-den drum instruments; matching card game; and 2 home CDs. NOTE: Non-refundable as your materials are purchased upon enrollment. $69 per child for 5 weeks. Payment plans available. Tuition not due until classes begin unless on payment plan. Total cost = Tuition + Registration
1st Child's Name: *
1st Child's Gender: *	Male Female
1st Child's Birthdate: *
2nd Child's Name:
2nd Child's Gender:	Male Female
2nd Child's Birthdate:
3rd Child's Name:
3rd Child's Gender:	Male Female
3rd Child's Birthdate:
Materials Needed: *	Require Full Home Materials (Required if never taken) Need Sibling Kit Only (Own partial materials only) Have Full Home Materials Kit (Must present to educator)
Class Choice: *
2nd Class Choice: *
	Please check box if re-enrolling.
Do any of your children have any allergies or special needs? *	Yes No
If yes, please list all special needs or allergies of which we should be aware.
Parent's Name(s): *
E-mail: *
Home Phone: *
Cell Phone:
Work Phone:
Street Address: *
City/State/Zip: *
Adult Attending Class (if other than parent):
How did you hear about us?
Tuition Options	I would like to discuss tuition payment plans.
Movin' and Groovin' Registration
	When you click the Submit button, you will be taken to a secure payment page. You will be able to pay the registration fee using your credit card or PayPal.