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Child's Name

Child's Age

Allergies / Medical Concerns

Parent or Legal Guardian

Person(s) Authorized to Pick Up Child

Address

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(red denotes Red Bank Rockers Classeses)

Spring Semester: April 18 - June 27 (10 weeks)

Me & Momma Rock (w/parent or caregiver)
Me & Momma Rock (w/parent or caregiver)
Pre-K of Rock 'n Art (drop-off - ages 3-5)
Keyboard Beginnings 2 (w/parent or caregiver)
Keyboard Beginnings 1 (w/parent or caregiver)

@ 9:30am - 10:30am
@ 11:00am - 12:00pm
@ 12:30pm - 2:30pm
@ 4:00pm - 5:00pm
@ 5:00pm - 6:00pm

Me & Momma Rock (w/parent or caregiver)
Sing, Dance, Draw & Prance (drop-off - ages 3-5)
Prince & Princess Academy (drop-off - ages 3-7)
Jam On (drop-off - ages 4+)

@ 9:30am - 10:30am
@ 12:30am - 2:30pm
@ 2:30pm - 3:30pm
@ 4:00pm - 5:30pm

Art With Momma (w/parent or caregiver - ages 2½-4)
Art Solo (drop-off - ages 3½-5)
Rhythm Rompers (drop-off - ages 3-5)
Sing, Dance, Draw & Prance (drop-off - ages 3-5)
Prince & Princess Academy (drop-off - ages 4+)
Pajama Jam (w/parent or caregiver)

@ 9:30am - 10:30am
@ 11:00am - 12:00pm
@ 12:30pm - 1:30pm
@ 2:00pm - 4:00pm
@ 4:00pm - 5:00pm
@ 6:00pm - 7:00pm

Me & Momma Rock (w/parent or caregiver)
Me & Momma Rock (w/parent or caregiver)
Pre-K of Rock 'n Art (drop-off - ages 3-5)
Sing, Dance, Drum & Prance (drop-off - ages 3-6)
Jam On (drop-off - ages 7+)

@ 9:30am - 10:30am
@ 11:00am - 12:00pm
@ 12:30pm - 2:30pm
@ 3:00pm - 4:00pm
@ 4:15pm - 5:45pm

Me & Momma Rock (w/parent or caregiver)
Me & Momma Rock (w/parent or caregiver)
Fitness Friends (drop-off - ages 3-6)
Sing, Dance, Draw & Prance (drop-off - ages 3-6)
Friday Night Parents Night Out (drop-off - ages 3+)

@ 9:30am - 10:30am
@ 11:00am - 12:00pm
@ 12:30pm - 2:30pm
@ 2:00pm - 4:00pm
@ 4:30pm - 8:30pm

Me & Daddy Rock (w/parent or caregiver)

Total Cost

Honey Child Music + Red Bank Rockers Agreement Waiver

This release and consent is signed by the natural parent or Legal guardian specified above for the period as defined in this program schedule per current active registration. I (We) confirm that we have received a copy of this release, have read it fully and understand and agree to it's terms.

The undersigned assumes all responsibilities for all risks, damages or injury which may occur while participating in Honey Child Music or Red Bank Rockers Classeses or programs using all instruments and equipment and while following the instruction of Sherri Ehrlich or any other of her instructors in or out of our studios. The undersigned furthermore, hereby releases and discharges Honey Child Music + Red Bank Rockers, it's owners, employees, instructors and agents from any or all claims or damages arising from participation in the aforesaid Classeses and instruction.

The undersigned parent/guardian herein releases Honey Child Music and Red Bank Rockers and or assigned agents from future claims for compensation. Upon these agreements I have signed this document today payment in full is necessary to guarantee a spot in the program. Full refunds may be issued prior to the first day of Classeses, after such a point, only credit may be issued toward Honey Child Music or Red Bank Rockers Classeses or parties. Honey Child music reserves the right to cancel or modify Classeses and faculty. A $30 fee will be charged for all returned checks. Two make ups are permitted per child, per semester within the given semester. No refunds will be issued for missed Classeses. I have carefully read, understand and comply with these terms.

I, agree to the above waiver.

After clicking "SUBMIT" below, you will be taken to PayPal to complete payment for your classes.
YOUR REGISTRATION IS NOT COMPLETE UNTIL PAYMENT HAS BEEN MADE.