Please fill out the form below and submit, thank you.

Parent's Name Email
Mailing Address
Telephone (H) (C)

Adult attending if other than parent Phone

Emergency Contact Phone

How did you hear about Learning Allegro?
Website Community Event
Advertising Word of Mouth
Other

Class:
1st Child's Name DOB


2nd Child's Name DOB


With this enrollment, I release any and all rights and claims for damages against Learning Allegro and it's staff in the unlikely event of injury sustained by myself or my child(ren) during the course of or as a result of this musical activity.
Sign Date

You have my permission to use photography or video taken of my child during class.

Payment Method: Cash/Check   Credit card through PayPal
Discount/Coupon Code: