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

Studio: Maple Ridge Returning New

Jollyjumpers (newborn to 18 months) / Class time and day: None Jollyjumpers Tue 11:45 Jollyjumpers Fri 10:30
Fees $195.*Please note that there are no CDs for this program. If using payment plan, Deposit $55 plus post dated cheques for $35 dated the 15th of Sept-Dec.

Puddlejumpers (16 mo to 3 1 /2 yrs) / Class time and day: None Puddlejumpers Tue 10:45 Puddlejumpers Fri 9:30
Fees $195.*Please note that there are no CDs for this program. If using payment plan, Deposit $55 plus post dated cheques for $35 dated the 15th of Sept-Dec.

Cycle of Seasons (3-5 Years) / Class time and day: None Cycles Tue 9:30
Fees $235 / 16 weeks. *Payment plan: Deposit $65 plus post dated chqs for $42.50 dated the 15th of Sept, Oct, Nov, Dec. ***CYCLES "SUMMER"- (Please note that SUMMER is the only remaining CD in use from the previous series. The others are new

Alternate Class Time Desired (if available)

Personal Information:

New families, how did you hear about us?

Print Ad Event Internet

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 we do not have an office in Maple Ridge, only classrooms. Our teachers are unable to provide receipts or change cash at our Maple Ridge locations.

• FAMILY DISCOUNT: If you have more than one child registering, your first child pays full price. Your subsequent children deduct $20. If you are using payment plan, please make deductions from deposit.)
• CD DISOUNT: If an older child has already recieved the FIRST NOTES / PIANO CD, or the CYCLE OF SEASONS SUMMER CD,please note that you will AUTOMATICALLY BE ORDERED THE SIBLING KIT WITHOUT CD, unless you notify us in the comments section. Deadline for ordering CD's to ensure timely arrival is: June 15.
• SELECT CYCLES DISCOUNT IF YOUR OLDER CHILD HAS ALREADY ATTENDED:
  CYCLES "SUMMER" CD - DEDUCT $10 FROM TOTAL
• List any other coupons / discounts here:
• Arranging a Group? / Referring your friends? List your 5 friends here so we can watch for their registrations:

Payment Amount :
Additional payment instructions / comments:

I will be paying by:

In full by cheque- (same address as payment plan)

Payment Plan- Please note that all cheques (both the deposit and post dated monthly payments) must be recieved in order to complete your registration. Send all cheques to our mailing address at #74-1240 Falcon Drive, Coquitlam, BC V3E 2B4

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.