Registration Form | Music with Rivky

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

Schedule:

The class will be held on Sunday, November 18, 2018 at 4:30pm.

Classes are for children ages 0-6 and will be held at the Jewish Discovery Center's NEW Learning Center, 831 Maple Rd. Suite 110 (building near Maple West Elementary School.)

Classes typically fill up quickly. We have had some very large classes and we all had fun! I do however have to limit the group size based on the age of the children. Please register as early as possible, as I do accept moms on a first-come first-serve basis.

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 - $12.00
2 Children - $18.00
3 Children - $24.00
4 Children - $30.00

Your Name*

First Last

Home Phone*

Cell Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Preference*

E-mail
Phone

Child 1 Name*

First Last

Child 1 Date of Birth*

Child 2 Name

First Last

Child 2 Date of Birth

Child 3 Name

First Last

Child 3 Date of Birth

Child 4 Name

First Last

Child 4 Date of Birth

Missed Classes

By registering, you are signing up for the Pre-Chanukah 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.