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. If using payment plan, Deposit $65 plus post dated cheques for $32.50 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. If using payment plan, Deposit $65 plus post dated cheques for $32.50 dated the 15th of Sept-Dec.

Cycle of Seasons (3-5 Years) / Class time and day: None Cycles Tue 9:30
Fees $215. If using payment plan, Deposit $65 plus post dated cheques for $37.50 dated the 15th of Sept-Dec.

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.

• 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.