Registration
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Join us for an "Olympic" themed musical celebration for the whole family at the Upper St. Clair Community & Recreation Center at Boyce Mayview Park. All of our Kindermusik and Piano Corner families are invited to attend! The fun begins at 2:30 PM on Saturday, February 10th with music, dancing, crafts, and games! Dress up as your favorite country, sport, or athlete. We will have a special area designed just for babies to play.
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:
What is your child's first & last name (that is enrolled in Kindermusik)?
How many children are planning to attend?
How many adults are planning to attend?
Additional Information:
Release of Liablity
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With this RSVP, I release any and all rights and claims for damages against Kathy's Music and its Staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of my participation at this event sponsored by Kathy's Music, LLC.
I've read the above and agree.
Photography/Video
(Show-Hide Details)
I understand that pictures and video may be taken during this special event to share with families as part the celebration and possible future promotion.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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