Select Age Group and class time for a maximum of 2 children:
(Please put additional children on a separate form.)

Studio: Coquitlam Returning New

Jollyjumpers (newborn to 18 months) / Class time and day: None Monday 9:45 Jollyjumpers Tuesday 9:45 Jollyjumpers Tuesday 5:45 Jollyjumpers- Groups only Tuesday 6:45pm Jollyjumpers Wednesday 10:45 Jollyjumpers- Thursday 10:45 Jollyjumpers- Thursday 12:30pm Jollyjumpers Friday 12:15 Jollyjumpers-FULL Saturday 10:45 Jollyjumpers- Saturday 12:30pm Jollyjumpers Fees $195 / 16 weeks (Curriculum- FMB I)
Pmnt plan: Deposit $65, plus 4 chqs for $32.50, dated the 15th of Feb-May

Bounce Back Post-natal Fitness (4 weeks post-partum with pre-walking baby) Class time and day: - Thu 1:30 pm Bounce Back
Feb 14 to April 10. Fees $80 or $72 when signing up for both BB and Stroller class.

Stroll N Strengthen ( 1 or 2 stroller aged children) / Class time:
None Thu 1:30 Stroller 8 classes $80 Thu 1:30 Stroller 10 classes April 17-June 19. 8 weeks $80 / 10 weeks $90
Yes-Add Mat $21.40 No Mat

Puddlejumpers (16 mo to 3 1/2 yrs) / Class time and day: None Monday 9:45 Puddlejumpers Monday 10:45 Puddlejumpers Monday 6:45 Puddlejumpers- Tuesday 11am Puddlejumpers-FULL Tuesday 4:30pm Puddlejumpers-Cancelled Tuesday 6:45pm Puddlejumpers Wednesday 9:30 Puddlejumpers Thursday 9:30 Puddlejumpers Thursday 10:45 Puddlejumpers Friday 9:30 Puddlejumpers-FULL Friday 11am Puddlejumpers Saturday 9:30 Puddlejumpers FULL Saturday 10:45 Puddlejumpers Saturday 12:30pm Puddlejumpers Fees $195 / 16 weeks (Curiculum- Sing With Me)
Pmnt plan: Deposit $65, plus 4 chqs for $32.50, dated the 15th of Feb-May

Cycle of Seasons (3 to 5 yrs) / Class time and day:
None Monday 10:45 Cycles-FULL Monday 6:45 Cycles Tuesday 9:45 Cycles Wednesday 6:45pm Cycles Thursday 9:30 Cycles Thursday 6:45pm Cycles Saturday 9:30 Cycles FULL Saturday 12:30 Cycles Fees $215 / 16 weeks (Curriculum- Spring)
Pmnt plan: Deposit $65, plus 4 chqs for $37.50, dated the 15th of Feb-May

In the event that your class is full, please indicate another suitable class time(s): (optional)

Personal Information:

New families, how did you hear about us?

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Friend - Frient / Event Name:

Parents' Names: (first & last please)
Adult attending if not parent:
Email:
Phone:

Child's Name 1 (first and last)
Birthdate:
Child's Name 2 (first and last)
Birthdate:
Address: City:
Postal Code:

Payment information: **Please note that for security reasons, we do not advise dropping payments off with other merchants in our building.

• Sibling Discounts: If you are using payment plan, please make deductions from deposit.
• If you have more than one child registering, your first child pays full price. Your subsequent children deduct $20.
• Families whose older children previously attended the exact curriculum listed and have the cd, may choose not to receive the cd/parent book and receive a further $10 discount.

I am registering a 2nd, 3rd or 4th child on this form and will be deducting $20 from my total.
List any other coupons / discounts here:

Payment Amount :
Additional payment instructions / comments:

I will be paying by:

Payment Plan Option: a deposit plus post-dated cheques (see payment schedule beside class selection).
Please mail cheques to our mailing address at: Jump Start Music & Movement #74-1240 Falcon Drive, Coquitlam, BC V3E-2B4. (Alternately, you may drop payment at our 98 Brigantine Drive location Tues-Thu from 4pm-8pm or Saturdays from 9:30-1:30)

In full by cash- Drop payment at our 98 Brigantine Drive location on Tues, Wed, Thurs between 5pm-8pm or Saturdays from 9:30-1:30

In full by cheque- (mail to above address)

In full by credit card - You will be automatically directed to the secure credit card page after submitting this form.

Policies:

Please click the link to the left to view our policy page.

I the undersigned have read and understood the attached policies and agree to the terms within. I wish to register my child for the class indicated. I understand that photographs taken in class may be used without financial compensation, unless ohterwise indicated by me in writing. Checking this box indicates my agreement that I will not hold Jump Start Music & Movement responsible for any loss, damages or injury incurred directly or indirectly from participation in the Jump Start Program. If paying by credit card, checking this box also constitutes authorization to charge said card.