Music Together by the Dunes

For Credit Card registration:

First copy and fill out the following information and email to: Ina Ferrara, Center Director

Then use the chart at the bottom of the page to pay for your session fees. (Make sure to include NEW FAMILY registration fee if necessary.)

You will receive confirmation via email 48 hours after payment has been confirmed.

Name (Parent's):________________________  Caregiver_____________________

Address: ____________________________________________________________

City: ___________________________  State: ____  Zip Code: ________________

Home Phone: (____)_________________  Work Phone: (____)________________

E-mail: ______________________________________________________________

Child #1: _____________________________  Birthday: _______________________

Child #2: _____________________________  Birthday: _______________________

FIRST Choice class ______________________________

SECOND choice class__________________________________________

Total payment sent via Paypal___________________________________________

NEW FAMILIES: How did you hear about us? Thank you!_______________________

If you have a different summer and winter address, please give both.