Spring 2011 Session will be a 10-week session from Mar. 7 - May 20. No class during spring break; make-

ups week of May 22, if needed. Please indicate preferred enrollment option.

Child’s Name: ____________________________________ Birthdate: ______________

Early Childhood Music & Movement Classes

Registration Form: Spring 2011 Session

INFANT/TODDLER CLASSES (Birth-3)

___ Tuesday, 5:30-6:15pm ($150)

___ Saturday, 10-10:45am ($150)

PRESCHOOL CLASSES (3-5)

___ Tuesday, 6:30-7:15pm ($150)

___ Saturday, 11-11:45am ($150)

Indicate Payment Method: Cash___ Check___ Money Order___ Make checks payable to: CODA Music Therapy Services, LLC

___ Paid in full ___ Pay in two installments, balance will be due APRIL 16

Providing Creative Opportunities for Developing Abilities

P.O. Box 81003 Lansing, MI 48908 www.codamts.com (517) 862-4675

The Early Childhood Division of

___ Yes, I qualify for the Military Rate ($120)

___ Yes, I have already registered another child for SPG Classes. Sibling Rate: $120

Name of sibling: ________________________________

___ Yes, I have a discount coupon! (May not be combined with military or sibling rate.)

Coupon code: __________ Discount Amount: ________

___ Yes, I am registering by February 25, 2011. Early Bird Discount: $10 off

(Early Bird Discount may be combined with other discount.)

Registration Cost: ________

Discount Amount: ________

Registration Total: ________

Early Childhood Music & Movement: Enrollment Form

Child’s name: ___________________________________________ Birthdate: ____________________

Parent/Guardians’ name(s): ___________________________________________________________________

Address: __________________________________________________________________________________

City: _____________________________________________ Zip: ________________________

Phone: (____)________________________ E-mail: ________________________________________________

What kinds of music & movement experiences does your child receive at home? ________________________

__________________________________________________________________________________________

Does your child have any special needs and/or allergies? ___________________________________________

__________________________________________________________________________________________

Is there anything else important for us to know about your child? ____________________________________

__________________________________________________________________________________________

____ Yes, photos and/or video of my child participating in CODA MTS ECM&M classes may be used in

advertising (print and/or web-based) and/or professional presentations.

____ No, photos/video of my child may not be used by CODA MTS.

I agree to enroll my child in Sing Play Grow classes with CODA Music Therapy Services, LLC. I understand

payment is due at the time of registration. I understand that a parent/guardian must attend classes with my

child and I am responsible for the care of my child.

Parent/Guardian Signature: ____________________________________________ Date: __________________

Providing Creative Opportunities for Developing Abilities

P.O. Box 81003 Lansing, MI 48908 www.codamts.com (517) 862-4675

The Early Childhood Division of