Sprouting Melodies 3 Registration Form

Registration Form

Sprouting Melodies 3: 18 months - 3 years
Child Information

Note: If multiple children are enrolling in classes please fill out child information separately for both children. Children with disabilities are welcome!
Child Name #1

First Name Last Name
Age in Months
Birth Date

Month Day Year
Date
Gender

Male Female
Any relevant personality, development information, and/or special needs?
Child Name #2

First Name Last Name
Age
Birthdate:

Month Day Year
Date
Gender

Male Female
Any relevant personality, development information, and/or special needs?
Parent Information
Name

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Caregiver Information

(If someone other than a parent will be bringing child to classes)
Name

First Name Last Name
Relationship to Child:
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
How did you hear about our classes?
All classes will be held virtually due to the COVID-19 Pandemic
Rates and Discounts:

$100 per 4 class series
Current discounts and promotions:
- Registration fees are being waived during the COVID-19 pandemic.
- Parents working in hospitals or nursing homes are eligible for a $50 discount.
- The sibling rate for additional children if two or more children are registered for classes the same semester is $60.
Class rate includes tuition, an instrument, scarf, and professionally recorded digital parent album.
Class Cost(s):
Minus Discount:
Please note discount used:
Total Due:
Payment due by the first day of class
Payment Method
You may pay by check if you reside in MN. Contact melissa@livingspirittherapy.com if you would like to pay by check. Credit Card
Use the section below for secure credit card payment:

Please Enter Total Due

USD Description

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Registration Form

Child Information

Parent Information

Caregiver Information

All classes will be held virtually due to the COVID-19 Pandemic

Rates and Discounts:

Payment Method

Use the section below for secure credit card payment: