Summer Registration

By registering before June 17th, you will save $10! Just enter the promotional code EARLYBIRD during online payment or write it in the memo line of your check mailed on or before June 17, 2013.

Parent's Name* First Name	First Name is required.
Last Name	Last Name is required.
Address*	Address is required.
City*	City is required.
State*	State is required.	Zip*	Zip is required.Invalid format.
Phone Number*	Phone Number is required.	Cell Phone
Email*	Email Address is required.Invalid format.
How would you like us to contact you?* Home Phone Cell Phone Email Please make a selection.

Name of First Child*	Birthday
A name is required.
Name of Second Child (Sibling)	Birthday

Name of Third Child (Sibling)	Birthday

**Name of Free Child (Sibling)	Birthday

**Children under 6 months as of the semester's start date are free with a registered sibling.

1st Class Choice*	Please select a class.Please select an item.
2nd Class Choice*	Please select a class.Please select an class.

Have you taken classes with Tempo! or Music Together before?* Yes No
Please make a selection.
If no, please pay online as a new family or add $15 to your check.

How did you hear about us? (please choose one)

Friend

Resource Event

Print Ad

Music Together National Site

Google Search

Teacher/School

Therapist/Medical Professional

Other

Additional Comments

I have read and agree to all Tempo! Music Therapy Services *
Please verify that you have read the policies and procedures.

*e-Signature

Full Name:
Enter your full name.

Date: mm/dd/yy
Enter Today's Date.Invalid format.

*Required

I will pay online with my credit card number. (A link will be available on your confirmation page.)
I will send a check within the next 3 business days. Click here for the address.
Please make a selection.

To view our class prices, please click here.