Milford Square Music Studio
2244 Milford Square Pike / PO Box 199
Milford Square, PA 18935
(215)536-8142
www.msmusicstudio.com
Teacher:
Catherine Worner
Spanish Registration Form
Spanish for Ages 3-7 and Spanish Language and Culture for Ages 8 and up
2014 Summer Session
(Please print clearly)
Name of Student ________________________________________________ Birthdate _______________
Address ______________________________________________________________________________
Street
City/Town
Zip
Telephone (________) ___________________________________________________________________
Email ________________________________________________________________________________
Mother’s Name ________________________________________________________________________
Mother’s Cell (________) ________________________________________________________________
Father’s Name _________________________________________________________________________
Father’s Cell (________) _________________________________________________________________
Emergency Name and Phone Number (________) _____________________________________________
Siblings: Name _________________________________ Birthdate ____________________________
Name _________________________________ Birthdate ____________________________
Name _________________________________ Birthdate ____________________________
I first learned about this program from:
A Friend _______
Name of Friend ______________________________ Road Sign _______
Our Website _______
Other _______________________________________________________
5-WEEK SUMMER SESSION:
6/19, 6/26, 7/3, 7/10, 7/17
Please check the appropriate class:
SPANISH (Ages 3-7 years): La Comida (Food) – will be learning about food using Spanish vocabulary in
songs and activities; will create a placemat with favorite breakfast, lunch and dinner foods.
$70 tuition _____
$65 for 2nd or 3rd child_____
Thursday 5:30 – 6:15 pm _____
SPANISH (Ages 8 and up): Spanish Culture, exploring Argentina, Mexico and Spain – will take home
recipes to try, experience regional dress, customs, art and music using as much of the target language as
possible for comprehension. As a special enhancement, a husband and wife team who conduct ballroom
dance classes will be coming to the last ½ hour of four of the classes to teach the Latin dances, the Cha Cha
and the Mambo for child and parent to share together.
$90 tuition _____
$80 for 2nd or 3rd child______
Thursday 6:30 – 8:00 pm _____
All fees are due by June 12th, 2014.
I would like to inquire about a payment plan. ________ Call 215-536-8142 to set one up.
PLEASE TURN OVER AND FILL OUT OTHER SIDE.
Make check payable to: Milford Square Music Studio
PO Box 199 Milford Square, PA 18935
Milford Square Music Studio
2244 Milford Square Pike / PO Box 199
Milford Square, PA 18935
(215)536-8142
www.msmusicstudio.com
Teacher:
Catherine Worner
I give permission to Milford Square Music Studio to use photos of me or my child(ren) in newsletters,
emails, marketing materials, or websites. (No last names or addresses are used.) Yes _____ No _____
May we use a first name? Yes _____ No _____
May we use the photo if no name is included? Yes _____ No _____
May we use a large group photo in which your child appears? (No first or last names will be
included.) Yes ___ No____
I give permission to Milford Square Music Studio to use photos of me or my child(ren) on our studio
Facebook page. (No last names or addresses are used.) Yes _____ No _____
May we use a first name? Yes _____ No _____
May we use the photo if no name is included? Yes _____ No _____
May we use a large group photo in which your child appears? (No first or last names will be
included.) Yes ___ No____
Signature of Parent ______________________________________________ Today’s Date ____________
Make check payable to: Milford Square Music Studio
PO Box 199 Milford Square, PA 18935