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 Monday 5:45pm Jollyjumpers Tuesday 9:45 Jollyjumpers Tuesday 6:45pm Jollyjumers Wednesday 10:45 Jollyjumpers-FULL Thursday 10:45 Jollyjumpers-FULL Thursday 12:30pm Jollyjumpers Friday 12:15 Jollyjumpers Saturday 10:45 Jollyjumpers- Saturday 12:30pm Jollyjumpers CD- Family Music For Babies II- Fees $195 / 16 weeks. Payment plan: Deposit $65 plus post dated chqs for $32.50 dated the 15th of Sept, Oct, Nov, Dec

Puddlejumpers (16 mo to 3 1/2 yrs) / Class time and day: None Monday 9:45 Puddlejumpers Monday 10:45 Puddlejumpers Monday 12:45 Puddlejumpers Monday 5:45 Puddlejumpers Monday 6:45 Puddlejumpers- Tuesday 11am Puddlejumpers Tuesday 6:45pm Puddlejumpers Wednesday 9:30 Puddlejumpers Thursday 9:30 Puddlejumpers Thursday 10:45 Puddlejumpers Friday 9:30 Puddlejumpers Saturday 9:30 Puddlejumpers- FULL Saturday 10:45 Puddlejumpers- FULL CD- Dance With Me Fees $195 / 16 weeks. Payment plan: Deposit $65 plus post dated chqs for $32.50 dated the 15th of Sept, Oct, Nov, Dec

Cycle of Seasons (3 to 5 yrs) / Class time and day:
None Monday 10:45 Cycles- Monday 6:45 Cycles Thursday 9:30 Cycles Thursday 3:45pm Cycles Thursday 6:45pm Cycles Friday 11am Cycles Saturday 9:30 Cycles- Saturday 12:30 Cycles CD-FALL Fees $215 / 16 weeks. Payment plan: Deposit $65 plus post dated chqs for $37.50 dated the 15th of Sept, Oct, Nov, Dec

First Notes (5&6 yrs) / Class time and day:
None Monday 12:45pm First Notes Thursday 5:15 First Notes Saturday 9:30 First Notes-FULL Fees $430 / 32 weeks. Payment plan: Deposit $70 plus post dated chqs for $45 dated the 15th of Sept, Oct, Nov, Dec, Feb, Mar, Apr, May

Keyboard (7-9 yrs / 6 yrs if taken First Notes) / Class time and day:
None Wed 5:15 Keyboard I Thu 3:45pm Keyboard I-FULL Sat 9:30am Keyboard I Wed 6:45pm Keyboard II Thu 5:15pm Keyboard II Fees $715 / 36 weeks. Payment plan: Deposit $115 plus post dated chqs for $60 dated the 15th of Sept through June.

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.
• Families whose older children previously attended the EXACT curriculum listed (above) and have the cd, may choose not to receive the cd/parent book and receive a further $10 discount.
• If you have more than one child registering, your first child pays full price. Your subsequent children deduct $20.

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

Taking advantage of our 5 Friends Free Fun Offer? Have 5 friends new to Jump Start who will be registering this week? Let us know who to watch for:

Payment Amount :
Additional payment instructions / comments:

I will be paying by:

Payment Plan option: a deposit plus post-dated cheques (see fee schedule above) .
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 on Tuesdays and Thursdays from 4pm to 9pm or Saturdays from 9:30-1:30)

In full by cash- Drop payment at our 98 Brigantine Drive location on Tuesdays orThursdays from 4pm-9pm or Saturdays from 9:30-1:30

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

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.