Kindermusik with Jeanneane:: a good beginning never ends

Summer 2009 Registration & Fees
REGISTRATION FORM for School location Only

You may drop off your Registration form & Deposit at the School or mail it directly to:
Kindermusik with Jeanneane • 162 Lakewoods Ct. • Bloomingdale, IL. 60108
Cash, Money Order or Check Only. Please make checks payable to: Jeanneane Palczewski

Parents Name

Date

Address

City, State & Zip

Home Phone

Emergency Phone

Child’s Name

Date of Birth

Child’s age at start of Semester

Male Female

Bartlett Christian Academy
*Class Name*	*Day/Time*	*Tuition & Materials*
Jazz Kitchen	Wednesday 10:00 - 11:30	$80
Jazz Kitchen	Wednesday 12:30 - 2:00	$80
Total Due =

Paid in full option only - Unable do 2 payments since it is only a 5 week camp.

Families with more than one child in my program receive a special discount.
Contact Jeanneane Palczewski for more information.