Session Attending:

Step 1: Child Personal Information

If you have multiple children to enroll only enter one at a time.
Name of child: *
Age (In September) * Birth Date *
Parent or Guardian Name * Telephone *
Email *
1st Parent Work Tel: 2nd Parent Work Tel:
Street Address: *
City * Postal Code *

Step 2: Emergency And Medical Information

Emergency Contact Name * Emergency Telephone *
Health Card # (optional)
Allergies: (If Any) *
Medical Conditions: (If Any) *
Developmental DelayYes No
Does your child have a developmental delay?
If Yes, what is developmental delay?

Step 3: Referral Program
This optional program was created to encourage Music for Wee Ones participants to refer our program to their friends.

If you refer a new student to one of our 8-week Music for Wee Ones programs, you and your referral will each receive a 10.00 gift card of your choice. In order for you both to be eligible for this Program, the person being referred must also follow through and register for an 8-week program. Gift cards will be handed out on the first day.  Please Note: Each family is eligible to make three referrals.

I would like to refer (3 Max):
1st Person Referred:
1st Person Telephone 1st Person Email
Choose a Reward for 1st Referral
2nd Person Referred:
2nd Person Telephone 2nd Person Email
Choose a Reward for 2nd Referral
3rd Person Referred:
3rd Person Telephone 3rd Person Email
Choose a Reward for 3rd Referral