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Registration form Summer 2012
Your Name *
Name of other parent/guardian
Your Email Address *
Phone number *
Second phone
Mailing address *
City *
State *
Zipcode *
First class preference
Second class preference
1st Child's name
Birthdate
2nd Child's name
Birthdate
3rd Child's name
Birthdate
How did you hear from us?
May Whirligig Music use (class) pictures of your child for the website/promotion?
 yes 
 no 
Join our mailing list?
 yes 
 no 
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