Registration Form Fall 2011
To enroll, please complete form, print, then mail this registration form with your check made payable to:
Bartis' Creative Studio, 639 Scott Ave., GSO, NC 27403 or Fax: with credit card payment to 336-855-7062
Fall 2011
Click here for our
Courtesy Information
Village
Total Classes 15
Class Length 45 min.
Total $247
Adult in attendence
Our Time
Total Classes 15
Class Length 45 min.
Total $247
Adult in attendence
Imagine That!
Total Classes 15
Class Length 45 min.
Total $247
Adult attends last 15 min.

If you already have materials from a previous class OR if yo have two children participating in the same curriculum, please inquire about sibling packets of materials. This semester we will be doing the following units:
Village - Feathers & Do-Si-Do
Our Time - Wiggles & Giggles
Imagine That! - See What I Saw
Parent's Name(s):
Caregiver's Name
(if participating in class)
Address:
City/Zip:
Home Phone:
Other Phone:
e-mail:
New to program or previously enrolled
Emergency Contact:
Phone:

How did you hear about the Kindermusik program:

Does your child have health or learning challenges or Food Allergies we should know about?
yesnoPlease attach further info.

Child's Name 1:
Age/Birthday:
Choice #1:
Day/Time/Location
Choice #2:
Day/Time/Location
Total Due Child 1: $
Child's Name 2:
Age/Birthday:
Choice #1:
Day/Time/Location
Choice #2:
Day/Time/Location
Total Due Child 2: $ deduct $10 for each additional sibling
Child's Name 3:
Age/Birthday:
Choice #1:
Day/Time/Location
Choice #2:
Day/Time/Location
Total Due Child 3: $ deduct $10 for each additional sibling
Grand Total: $
registration promo
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Payment Options
Payment by check
Payment with credit card: Visa or MasterCard
Cardholder Name:
Credit Card Number:
vin # three digit number on back of card
Exp. Date:
Billing Address:
City & Zip Code:
Because materials are not re-useable, I understand my responsibility for the cost of materials, once we are registered for a class. Additionally, I understand that I have made a commitment for my child to participate in the above class. Should we find that, after the class has begun, we are unable to keep this commitment, I understand that my tuition and fees are non-refundable.
* Signature
Please Sign
Date:
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Bartis' Creative Studio
639 Scott Avenue
Greensboro, NC 27403

336-294-0500
stephaniebartis@hotmail.com