Children's Music
Registration

IMPORTANT NOTICE - Credit Card Payments can be made by clicking on the Buy Now button located on the Classes page.  Please follow these instructions.
 
Credit Card Payments
1. Complete this form.
2. Go to the Classes page.
3. Select a class.
4. Select the number of classes you will attend. 
5. Click the Buy Now button. 

Make checks payable to:  Peggy Durbin
                                       3614 Valley Rd.
                                       Ellicott City, MD  21042
                                             


Select Class:  
Preferred Day/Time: 
Preferred Location:  
Parent's First Name:  
Parent's Last Name:  
Address Line 1:  
Address Line 2:  
City:  
State:           Zip Code:  
Email Address:  
Home Phone Number:   -   -  
Work Phone Number:   -   -  
Cell Phone Number:   -   -  
Child's First Name:  
Child's Last Name:  
Child's Current Age:   months     years
Child's Birthdate:   (MM/DD/YYYY)  
How did you
hear about us?:
Other:
Question/Comment:  
 

Kindermusik with Peggy Durbin410-428-1874durbinpeggy@gmail.com