Sing-&-Wiggle Registration Form for cash/check payments

Child&#39s First Name^*

Child&#39s Last Name^*

Child&#39s Birthdate^*

Parents' Names^*

Email^*

Address Line 1^*

Address Line 2

City^*

State^*

Zipcode

Home Phone

Cell Phone^*

Allergies/Medical Restrictions

For which session(s) are you registering?^*

Lewisburg Fall session 2019 (Oct 2-Dec 11) tuition $150, makeup day if needed: Dec 18
Lewisburg Winter session 2020 (Jan 8-Mar 11) tuition $150, makeup day: Mar 18
Lewisburg Spring session 2020 (Apr 8-Jun 10) tuition $150, makeup day: Jun 17
Lewisburg Fall 2019/Winter 2020/Spring 2020 Bundle, save 15%!, tuition $382.50
Beckley Fall session 2019 (Oct 5-Dec 14) tuition $150, makeup day if needed: Dec 21

Beckley classes are offered Saturdays at 10AM. Lewisburg classes are offered Wednesdays at 10AM and again at 5PM. Please select your class time:^*

10AM
5PM (Lewisburg location only)

Name(s) of adult(s) who will be attending class with the child:^*

Terms & Conditions^*

I understand that this course has set dates. Any student-missed classes will not be refunded or made up. Cancelled classes due to inclement weather will be announced by text message and a make-up class will be offered.

I accept

Permission to take photographs

I give HeartStrings Academy permission to use photographs taken during Sing-&-Wiggle classes for promotional purposes. Photos may be used in newspapers, marketing, website, social media, etc.

I accept

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Sing-&-Wiggle Registration Form for cash/check payments

HeartStrings Alexandria

HeartStrings Lewisburg

HeartStrings Beckley

Sing-&-Wiggle Registration Form for cash/check payments

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HeartStrings Alexandria

HeartStrings Lewisburg

HeartStrings Beckley