Name of person completing this form *

First Name

Last Name

Center Name/ School Name

Please skip to the next question if you are registering an individual child

First Name

Last Name

Home address *

What is your home address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this the location where you will want to hold classes? *

If this is not your preferred location, please complete the next field indicating either the school or facility name where you wish to hold classes.

Yes please come to my home for classes

No please see next address

I am registering for classes in a Lynn Musik location

School, Facility, or Home address where classes will be held

Please skip this question if you are completing for an individual at your home address or a Lynn Musik location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Adventures Participant Name

This is for individual participants. Please skip if you are completing for a school or facility

First Name

Last Name

Phone *

(###)

###

####

What is the age group of your participant or class? *

6 months to 12 months

12 to 24 months

24 to 36 months

Ages 3 and 4 (Potty Trained)

Ages 4 and 5 (Pre K)

Kindergarten-Second Grade

How Many Classes do you wish to attend? *

Two Classes Weekly

One Class Weekly

Bi-weekly Classes

Monthly Classes

Today's date *

MM

DD

YYYY

Please type your full name *

Make sure to check through your application, and if everything is correct type your full name to certify, thanks!

First Name

Last Name