Music & Movement Center at MYAC Registration

Child’s Information

Child’s First Name:
Child’s Last Name:
Home Phone:
Preferred E-mail:
Address:
City, State ZIP:,
Child’s Birthday (mm/dd/yy):(e.g. 10/15/12)
Parent 1 Name:
Parent 1 Employer:
Parent 1 Cell Phone:
Parent 2 Name:
Parent 2 Employer:
Parent 2 Cell Phone:

Session, Day, and Class Selection

Note: you can only register for one class at a time. If you need to register for multiple children, please fill out the form for each child.

All classes are open to a maximum of 10 children.

You must choose a session AND a class time/day. If the class you want is full, it will not show on the list. Email margueriteoines@mya.org to be put on the waitlist. We will let you know if your registration is confirmed.

Please Note: Classes for 3 years and older are without parent

Session:
Tuesday Classes:
Wednesday Classes:
Friday Classes:

Submit Your Form

Once you have verified that all the above information is complete and accurate, please click the button below.

Payment Information

Registration is open until the second class of each session. You may make a secure, on-line payment in the amount of $125 as soon as you register for the class, or you may bring in a check on the first class (preferred). Payment must be made in full by the 2nd class session or else a $10 late fee will be assessed.

Please note: Financial assistance is available.