EmailMe Form - Sing and Play Discovery Day

Choose ONE class from the following list for your child that is 18 months - 3 years old:

Choose ONE class from the following list for your child that is 3 - 5 years old:

Child's Name *

First Last

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

Ethnicity *

Parents or Guardians *

Child's Home Mailing Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Name *

First Last

Cell Phone *

### - ### - ####

Email *

How did you hear about our Preschool Music Classes? *

What is your combined household income? (Required for funding purposes.) *

$55,920 or less

$55,921 or more