Rockin' Tots With Darlene Graham Productions Inc ...
R egistration Form – FA LL 2016
To hold and reserve spot please mail check and registration form to: Darlene Graham Productions Inc. 17 Fern Terrace West Babylon NY 11704 FAMILY INFO:
Family Name:__________________________________Mother:________________________Father:_____________________ Address:____________________________________________________City:______________________ Zip:______________ Telephone Home:____________________________Work:________________________ Cell:___________________________ EMAIL ADDRESS:______________________________________________________________________________________ *Email is the fastest & easiest method of communication regarding classes – PLEASE PRINT CLEARLY*
Child’s name:________________________________________________________________DOB:_______________________ Second Child:________________________________________________________________DOB:_______________________ ($100 off the 2nd child registered in the same class)
CLASS INFO: 1st Choice – Class Location:_______________________________Day:__________________Time:___________________ 2nd Choice – Class Location:_______________________________Day:__________________Time:___________________ 3rd Choice – Class Location:_______________________________Day:__________________Time:___________________ *Registration is on a first come first serve basis. Form & payment must be received to hold your spot in a class.* You will be contacted, if you did not get your first choice of class. If you do not hear from us, you got your first choice. ***PLEASE DO NOT CALL LOCATIONS FOR INFORMATION, UNLESS INDICATED BELOW, PLEASE CALL (917)648-6891*** Monday Tuesday Wednesday Thursday Friday Carolyn’s DANCENTER Bubble Learning (Babylon) Carolyn’s DANCENTER Carolyn’s DANCENTER (Plainview) (Plainview) ROCKIN’ TOTS (Plainview) ROCKIN’ TOTS ROCKIN’ TOTS 10:00-‐10:45am ROCKIN’ TOTS-‐ALL AGES RESERVED 10:00-‐11:00am (walkers/partial sep) 10:00-‐10:45am(walkers) 11:00-‐11:45am 10:00-‐10:45am FOR 11:10-‐11:55am(all ages) 11:00-‐11:45am(all ages) 11:00-‐11:45am CONCERT 12:00-‐12:45pm (infants) (call “Bubble” directly to 12:00-‐12:45pm (infants) 12:00-‐12:45pm BOOKINGS (starts 9/16/16) register for these classes 12 WEEK SESSION -‐ $384 (starts 9/12/16) (starts 9/14/16) ONLY – 631-‐587-‐0050 PARTIAL SEPARATION -‐ $420 12 WEEK SESSION -‐ $384 12 WEEK SESSION -‐ $384
PAYMENT INFO: 12 WEEK SESSION - $384 ~ PARTIAL SEPARATION CLASS - $420 Make up dates & times are dependent upon space availability in each class. You must schedule this makes up in advance. If I cancel a class then we will add that class on at the end and extend the semester. Form of Payment: ___Check ___Cash ___Credit (3% charge applied to credit card payments) (Full payment due upon registration) ___Visa ___Mastercard Card Number:_______________________________ Exp. Date:_______________ 3-Digit Security Code:_______
*No refunds after first week of classes* PARENT OR GUARDIAN, PLEASE READ THE FOLLOWING AND SIGN BELOW: I agree to assume responsibility for my child (ren) and myself and/or caregiver when upon the premises operated by Rockin’ Tots! Darlene Graham Productions Inc., and will hold harmless Rockin’ Tots!, Darlene Graham Productions Inc, and any of its employees and/or agents in the event of any personal injury, property damage or loss, indemnifying said parties of any loss that I might incur as a result.
Signature (Required for registration) ______________________________________________Date_______________________
Rockin’ Tots With Darlene Graham Productions Inc. [email protected] - 917-648-6891
To hold and reserve spot please mail check and registration form to: Darlene Graham Productions Inc. 17 Fern Terrace West Babylon NY 11704 FAMILY INFO:
Family Name:__________________________________Mother:________________________Father:_____________________ Address:____________________________________________________City:______________________ Zip:______________ Telephone Home:____________________________Work:________________________ Cell:___________________________ EMAIL ADDRESS:______________________________________________________________________________________ *Email is the fastest & easiest method of communication regarding classes – PLEASE PRINT CLEARLY*
Child’s name:________________________________________________________________DOB:_______________________ Second Child:________________________________________________________________DOB:_______________________ ($100 off the 2nd child registered in the same class)
CLASS INFO: 1st Choice – Class Location:_______________________________Day:__________________Time:___________________ 2nd Choice – Class Location:_______________________________Day:__________________Time:___________________ 3rd Choice – Class Location:_______________________________Day:__________________Time:___________________ *Registration is on a first come first serve basis. Form & payment must be received to hold your spot in a class.* You will be contacted, if you did not get your first choice of class. If you do not hear from us, you got your first choice. ***PLEASE DO NOT CALL LOCATIONS FOR INFORMATION, UNLESS INDICATED BELOW, PLEASE CALL (917)648-6891*** Monday Tuesday Wednesday Thursday Friday Carolyn’s DANCENTER Bubble Learning (Babylon) Carolyn’s DANCENTER Carolyn’s DANCENTER (Plainview) (Plainview) ROCKIN’ TOTS (Plainview) ROCKIN’ TOTS ROCKIN’ TOTS 10:00-‐10:45am ROCKIN’ TOTS-‐ALL AGES RESERVED 10:00-‐11:00am (walkers/partial sep) 10:00-‐10:45am(walkers) 11:00-‐11:45am 10:00-‐10:45am FOR 11:10-‐11:55am(all ages) 11:00-‐11:45am(all ages) 11:00-‐11:45am CONCERT 12:00-‐12:45pm (infants) (call “Bubble” directly to 12:00-‐12:45pm (infants) 12:00-‐12:45pm BOOKINGS (starts 9/16/16) register for these classes 12 WEEK SESSION -‐ $384 (starts 9/12/16) (starts 9/14/16) ONLY – 631-‐587-‐0050 PARTIAL SEPARATION -‐ $420 12 WEEK SESSION -‐ $384 12 WEEK SESSION -‐ $384
PAYMENT INFO: 12 WEEK SESSION - $384 ~ PARTIAL SEPARATION CLASS - $420 Make up dates & times are dependent upon space availability in each class. You must schedule this makes up in advance. If I cancel a class then we will add that class on at the end and extend the semester. Form of Payment: ___Check ___Cash ___Credit (3% charge applied to credit card payments) (Full payment due upon registration) ___Visa ___Mastercard Card Number:_______________________________ Exp. Date:_______________ 3-Digit Security Code:_______
*No refunds after first week of classes* PARENT OR GUARDIAN, PLEASE READ THE FOLLOWING AND SIGN BELOW: I agree to assume responsibility for my child (ren) and myself and/or caregiver when upon the premises operated by Rockin’ Tots! Darlene Graham Productions Inc., and will hold harmless Rockin’ Tots!, Darlene Graham Productions Inc, and any of its employees and/or agents in the event of any personal injury, property damage or loss, indemnifying said parties of any loss that I might incur as a result.
Signature (Required for registration) ______________________________________________Date_______________________
Rockin’ Tots With Darlene Graham Productions Inc. [email protected] - 917-648-6891
