REGISTRATION FORM FOR KINDERMUSIK BIRTHDAY PARTIES PRESENTED BY MUSIKANDMOTION IN NATOMAS, SACRAMENTO, CALIF.   PRINT AND FILL OUT THIS FORM.

PLEASE MAKE CHECKS PAYABLE TO SUNNY S. KIRA.   FAX FORM TO: 530-756-9140; OR MAIL TO: DAVID KIRA, C/O M&M @ Med. Vis. Tech., 635 ANDERSON RD. SUITE 1, DAVIS, CA 95616.   INFORMATION: 916-419-6999.

COST: $125 for a 45-minute program for current and past Kindermusik families of Musikandmotion and by referrals only.

Parent(s):

 __________________________________________________________________________

Street address:

 __________________________________________________________________________

City/State/Zip:

 __________________________________________________________________________

Telephones:

 Home: ___________________ Work: ___________________ Cell: __________________

Email Address:

 __________________________________________________________________________

Child's Name:

 __________________________________________________________________________

 Gender: _______________________ Date of Birth: ________________________________


Are you currently enrolled in Kindermusik? __________________________________________________

Day & starting time of birthday party: ______________________________________________________

Approximate age ranges of children & number of guests: ________________________________________

How did you hear about us? ______________________________________________________________

Do you know someone currently enrolled at Musik and Motion? __________________________________

Please check if Musikandmotion may include images of you and your child in our on-line photo gallery and website: _______

* I have read and agree with Musikandmotion's studio policy. I do hereby release and forever discharge Musikandmotion, the studio instructor, and the studio owners, from any and all actions, claims and demands for, upon or by reason of damage, loss of personal injury which may be sustained by my child or myself during the course of or as a result of this musical activity.

** 40% NON-REFUNDABLE deposit is required at time of scheduling.

Name: ___________________________________________ Date: ________________________________