5-year oldsPlease enable JavaScript in your browser to complete this form.Which class would you like to register for? *Tuesdays from 2:10 - 3:00 PMYour Name *FirstLastEmail *Phone/Text *Preferred Method of Communication *EmailPhoneTextIn the event of an emergency during class, who should I call if you are not available? *FirstLastPhone *Relation *Child's Name *Prefers to be called...Child's Gender *MaleFemaleAge *Birthdate *Allergic to... *LikesDislikesI give permission to Mindy Rawlinson Piano School to use photos and videos of my child in the following ways: (please choose all that meet your level of comfort) *Group photos, no names attachedA photo or video of my child, no name attachedA photo or video of my child with first name only attachedNone of the aboveI like to take photos and videos of the fun we have in class so I can share with you and others on social media and in my advertising.How did you hear about me? *NameSubmit Registration Information
