1) Please Choose 1st,  2nd & 3rd Choice for class times.
The schedule below is all the class times that I can teach,
however, all class times may not fill so please select two class times.

2) Print registration form below

3) Registration forms must accompany the deposit which is listed
below and is NON-REFUNDABLE.

Please mail forms to me at 1107 9th Street Mukilteo, WA. 98275.
Make checks  payable to Bodge Music Academy.

4) There is a discount for families with children enrolled in the same class,
please ask to find out if you qualify.

5) Classes held at: 1107 9th Street Mukilteo, WA
Calendars are available in the studio on first day of class.
 

Child's Name: ____________________________________  Date of Birth: ________________

Name(s) of Parents: ___________________________________________________________

Address: ____________________________________  City___________________________Zip: _______________________

Home Phone w/Area Code: _________________________  Work Phone w/Area Code: ___________________________

Email Address: _______________________________

Health Concerns/Food Allergies?_________________________________________________________________________

Are there any medical or behavioral problems I need to be aware of?_____________________________________________________________________________________________________

How did you find out about Kindermusik:  Mailing_____Demo Class____Story Hour_____800 #________________

I would like to provide snack for one class - 8 children - (does not include juice, cups or napkins) and receive $10.00 tuition discount:  Yes____  No____
(No snack for piano camps)
 

Zoo Train
Ages 18 months- 4 years

DAY / TIME	START / LENGTH	LOCATION	STATUS	1st , 2nd or 3rd choice	TUITION FEE
Mondays 10:00 - 10:50 AM	June 30, July 7, 14, 21, 28 ( 5 classes )	Mukilteo	OPEN	________	$125.00
Wednesdays 6:00 - 6:50 PM	July 2-30 ( 5 classes )	Mukilteo	OPEN	________	$125.00
Thursdays 10:30 - 11:20 AM	July 3-31 ( 5 classes )	Mukilteo	OPEN	________	$125.00

Confetti Days
Ages 3 1/2 - 5 years old

DAY / TIME	START / LENGTH	LOCATION	STATUS	1st , 2nd or 3rd choice	TUITION FEE
Tuesdays 10:30 - 11:45 AM	July 1-29 ( 5 classes )	Mukilteo	OPEN	________	$135.00
Thursdays 1:00 - 2:15 PM	July 3-31 (5 classes)	Mukilteo	OPEN	________	$135.00

Adventures Around the World
Ages 41/2 - 7 years old

DAY / TIME	START / LENGTH	LOCATION	STATUS	1st , 2nd or 3rd choice	TUITION FEE
Mondays 1:00 - 2:30 PM	June 30, July 7-28 ( 5 classes )	Mukilteo	OPEN	________	$145.00
Wednesdays 3:30 - 5:00 PM	July 3-31 ( 5 classes )	Mukilteo	OPEN	________	$145.00

Blast Off With Piano
Ages  5 - 9 years

DAY / TIME	START / LENGTH	LOCATION	STATUS	1st , 2nd or 3rd choice	TUITION FEE
Mondays 6:00 - 6:45 PM	June 30, July 7-28 ( 5 classes )	Mukilteo	OPEN	________	$145.00
Tuesdays 5:00 - 5:45 PM	July 1-29 ( 5 classes )	Mukilteo	OPEN	________	$145.00
Wednesdays 10:00 - 10:45 AM	July 2-30 ( 5 classes )	Mukilteo	OPEN	________	$145.00
Thursdays 4:00 - 4:45 PM	July 3-31 ( 5 classes )	Mukilteo	OPEN	________	$145.00

VISA____  Mastercard_____  Name on Account_______________________________________________________
Account number___________________________________________Exp Date_________________________________
Signature_________________________________________________
Check number____________________________________________Amount___________________

In registering my child for_______________________________, I agree to pay $______________ for the camp selected.
Enclosed is the $_________________registration fee to hold my space in class.  I understand that the registration
fee is non-refundable, and that the tuition is due two weeks prior to the first day of class.  I have read the studio policy,
I understand it, and agree to abide by the rules and regulations.
Parent Signature: ___________________________________

Printed Name:  _____________________________________

Date: ______________________

Please make check payable to: Bodge Music Academy or Jessica Bodge  (not Kindermusik)  and mail with print-out of this Registration Form to: