Music Class Registration Form
Please PRINT, COMPLETE & MAIL this form with your payment to
The Musik Nest
4580 SE Klahanie Drive #245
Issaquah, WA 98029
Child’s Name:
________________________________________________
Parent’s Name:
______________________________________________
Address:_______________________________________________
City: __________________________ Zip Code: ____________________
Home Phone: ______________________ Work/Cell Phone:____________________
Email Address: ___________________________________________________
Child’s Date of Birth:
______________________________
Class Choice
_______________________
Day
_________________Time___________
Tuition is payable in
full and is due upon registration.
Checks should be made payable to The Musik Nest
Payment Type
- Check_____
Visa_____
Master Card____
Credit Card
#__________________________________________
Security
Code:_______
(This is the three digit
number on the back of your card)
Expiration Date:
_____/_____
I have registered
_____________________________
for a Music class
with The Musik Nest. I understand that a spot in the class has been reserved for
my child for the duration of the entire session. Furthermore, I waive and
release The Musik Nest and its affiliates, officers, members, employees,
attorneys, representatives, successors and assigns (collectively, the "Releasees"),
of and from, and promise never to institute, assert, prosecute or pursue, any
and all claims, charges, liabilities, claims for relief, demands, suits, action
or causes of action against the Releasees, whether based in contract or relating
to personal injury or damage to property, arising during the course or as a
result of this musical activity.
_______________________________________
Parent/Guardian
Signature