Registration Form | Music with Rivky

This registration form is for the upcoming Pre-Chanukah Music Class.

We are back in-person!

Schedule:
The class will be held on December 4, 2022 at 4:30pm

Classes are for children ages 0-6 and will be held at:

Jewish Discovery Center
831 Maple Road
Williamsville, NY 14221

Please register as early as possible as space is limited.

Please note: No child will be turned away due to lack of funds. Scholarships are available upon request by contacting Rivky here or e-mailing her at rivky@musicwithrivky.com. All information will remain strictly confidential.
Registration for Music Class*
- 1 Child - $16.00
- 2 Children - $24.00
- 3 Children - $32
- 4 Children - $40.00
I have a coupon code
- No
- Yes
Coupon
Your Name*
First Last
Home Phone*
Cell Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Preference*
- E-mail
- Phone
Child 1 Name*
First Last
Child 1 Date of Birth*
MM slash DD slash YYYY
Child 2 Name
First Last
Child 2 Date of Birth
MM slash DD slash YYYY
Child 3 Name
First Last
Child 3 Date of Birth
MM slash DD slash YYYY
Child 4 Name
First Last
Child 4 Date of Birth
MM slash DD slash YYYY
Missed Classes

By registering, you are signing up for the music class. However, we understand that life is busy and babies and toddlers are unpredictable. Missed classes due to illness or pre-advised holidays will be credited toward the next term’s attendance. A short message notifying me of this PRIOR to the missed class is required.
The class consists of some very young children. Please be considerate and do not come to class if you or your child has had any symptoms of illness and/or fever within 24 hours of the class. Make-up options will be available upon request.
Food allergies or special instructions
After you click "Submit", you will be taken to PayPal to complete payment using either your PayPal account or a credit card. If you do not complete payment, you will not be registered for the class.
At Music with Rivky we take photos of our events from time to time. We may use your photo on our web site, Facebook or other printed materials. If this causes a problem for you, just let us know.
Total
$0.00

Missed Classes