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

Attending 6 or 8 weeks? (If 6 weeks, please indicated the dates you will NOT attend.

Jollyjumpers (newborn to 18 months) / Class time and day: None (1) Tuesdays 11:45 Ultimate Baby 6 w eeks $60 8 weeks 70. No materials are handed out in shorter, summer classes. Add a super value package for $11.95 or $21.95 below!

Puddlejumpers (16 mo to 3 1/2 yrs) / Class time and day: None (1) Tuesdays 10:45 Puddlejumpers (2) Fridays 9:30 Puddlejumpers 6 w eeks $60 8 weeks 70. No materials are handed out in shorter, summer classes. Add a super value package for $11.95 or $21.95 below! Please note that the Monday evening class is only 7 weeks @ $65

Family Music & Story Time All ages. / Class Time and day: None (2) Family Music Fri 10:30 Designed for siblings 0-5 years.6 w eeks $60 8 weeks 70. No materials are handed out in shorter, summer classes. Add a super value package for $11.95 or $21.95 below!

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?

Print Ad Event Internet

Friend - Frient / Event Name:

Parents' Names: (first & last please)
Adult attending if not parent:
Email: Phone:
Cell /pgr: ***Parents with Cycle of Seasons and older children must leave a cell/ pager number if they intend to leave the waitng room during your child's class.
Address: City:
Postal Code:

Child's Name 1 (first and last)
Birthdate:
Child's Name 2 (first and last)
Birthdate:

Payment information: *Please note that we do not have a cashier at our Maple Ridge location. Teachers are unable to receive cash. Payments not received in FULL within 10 business days of submitting this form will result in cancellation of registration.

5 friends coming? List them here to particpate in our 5 friends offer:

Class Fee :
Super Value Package Fee: None Package A - $13.38 (incl tax) Package B- $24.58 (incl tax) Package C- $37.96 **If you would llike more than one package, please comment below on pmnt instructions.
Package A (bumpy ball + jumbo egg shaker) $11.95 +12%hst= 13.38
Package B (water drum set + pair of animal castanets) 21.95+12 hstt= $24.58
Total Cost: :

Additional instructions / comments:

I will be paying by:

In full by cheque- Please mail cheques to our mailing address at: Jump Start Music & Movement #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.

**Please note that because our office is in Coquitlam, registration is by phone or online only. We are unable to receive payments at Maple Ridge classes, they must be paid in advance by credit card or cheque.

Policies:

Please right click the underlined link above to view our policy page in a new window. **Please read policies carefully before submitting registration.

I the undersigned have read and understood the attached policies and agree to the terms within. I understand that no refunds are issued after the start of the 2nd class. I wish to register my child for the class indicated. I understand that photographs taken in class may be used without financial compensation, unless otherwise 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.