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Kathy's Music Gift Card - purchased in $50 increments. This gift card can be used toward Kindermusik, Group, or Private Lessons only. It does not hold any cash value. Cardholder has 5 years from date of purchase to use this card. Must present card to our office in order to apply amount to your account. NOTE: Please put YOUR name and address at the top of the form under "Family Information."
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Using Gift Card?:
Gift Card # (16 digits)::
Gift Card # (16 digits)::
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Using Gift Card?:
Gift Card # (16 digits)::
Gift Card # (16 digits)::
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Using Gift Card?:
Gift Card # (16 digits)::
Gift Card # (16 digits)::
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Using Gift Card?:
Gift Card # (16 digits)::
Gift Card # (16 digits)::
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Using Gift Card?:
Gift Card # (16 digits)::
Gift Card # (16 digits)::
Questions/Options:
Please Confirm: What is YOUR name?
Please Confirm: What is YOUR mailing address?
Do you want this gift card mailed to another address?
*
Yes
No
If yes, provide name and address of the person to receive the gift card.
*
What is your cell phone number in case we have questions about your order?
*
What is your email address?
*
Do you want to purchase more than $50 in Gift Cards? If yes, indicate amount in "Additional Information" section (ie $100, $200, etc). NOTE: Gift cards can only be purchased in $50 increments.
Yes
No
Additional Information:
Terms of use.
(Show-Hide Details)
I understand that this gift card may be applied to the card owner's account to be used for Kindermusik, Group Lessons, or Private Lessons only.
I've read the above and agree.
Value.
(Show-Hide Details)
I understand the card does not hold any cash value.
I've read the above and agree.
Terms of use continued.
(Show-Hide Details)
I understand that this amount is not automatically applied to a family account. The card or card numbers must be presented to the office in order to be applied to an account balance.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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