Musikgarten Musikgarten

itty bitty musik
Lincoln, NE  ~ 402.937.1970

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INSTRUCTIONS: (1) If registering for Pajama Class, please specify Tuesday, Thursday, or "either" in the "Preferred Day/Time" box. (2) If registering siblings/foster children, simply add the sibling's name and age in the "Question/Comment" box rather than registering twice. (3) Were you referred by a friend or family member? Please specify who referred you in the "Question/Comment" box so we can be sure to give our thanks!

Select Class:  

Preferred Day/Time:  (e.g. Tuesdays 09:30)
Preferred Location:  
Parent's First Name:  
Parent's Last Name:  
Address Line 1:  
Address Line 2:  
Zip/Postal Code:  
Email Address:  
Home Phone Number:   -   -  
Work Phone Number:   -   -  
Cell Phone Number:   -   -  
Alt. Contact Person:  
Alt. Contact Phone:   -   -  
Child's First Name:  
Child's Last Name:  
Child's Current Age:   months     years
Child's Birthdate:   (MM/DD/YYYY)  
List any allergies or medical issues of which the teacher should be aware:  
How did you hear about us?: