Parents’ Names ____________________________________________________________

Name of adults attending class (if different) ________________________________________

Address __________________________________________________________________

City _______________________________________ State __________ Zip_____________

email ______________________________________________

home phone _____________________________ cell___________________________________

work phone _____________________________ other phone _____________________________

1st Child’s Name _____________________________________ Date of Birth________________

2nd Child’s Name _____________________________________ Date of Birth________________

3rd Child’s Name _____________________________________ Date of Birth_______________

Does your child/children have any special needs? If so, please list them for us_____________

_____________________________________________________________________________

Is your child/children on any medications? If so, please list them here___________________________

_____________________________________________________________________________

Tuition Fees

$____________ $120 (12 weeks)

$____________ 10% off each additional sibling

$____________ Total Amount

Terms & Policies

Payment: Please make out checks and money orders to: The Gardiner Reformed Church

Mail To: Send registration form & payment to:

The Gardiner Reformed Church
PO Box 261
166 Main St.
Gardiner, NY 12525

Registration: Class spaces are reserved on a first-come, first-served basis. Spaces are reserved upon receipt of your registration form and tuition payment. We will notify you with class confirmation.

Refunds: Once your child's space is reserved, refunds can only be issued under certain situations. Tuition is for the entire semester regardless of attendance. Please note: in the event that a class is cancelled due to under enrollment, you may choose another class. If no other classes fit your schedule, we will issue you a full refund.

Inclement Weather Cancellations: Classes may be cancelled due to inclement weather. Please call Debbie
after 8am to confirm class cancellation 845-519-0751. If the New Paltz schools are closed, our classes will probably be cancelled. If New Paltz schools are on a 2 hour delay, we will most likely have our classes.

Class Previews: Parents and students are welcome to preview one class. If you decide to enroll, you will pay for the preview class. If not, there will be no charge for the preview class.

Class Make-ups: If you miss one of your weekly classes you may attend another class, space allowing. Please understand that our class sizes are limited therefore we can only allow 2 make-ups per semester. Class make-ups do not carry over into the next semester.

Personal Injury Liability: The Hot Diggity Dog Christian Music Program and the Gardiner Reformed Church are not liable for any injuries that might occur during classes.

Guests: Guests are always welcome, space allowing. Please call in advance if you would like to bring a guest to class (limited to one class per guest).

Returned Check Policy: There is a $30.00 fee for returned checks.

Please note: It is possible that your check may not be cashed until the first week of your session.

_____________ (please check off) I have read the terms and policies and agree with them.

Signed____________________________________________________________Date_________________________

OFFICE USE ONLY

Check# _____________

Amount _____________

Check Date ___________

Date Rec'd ______________

Class Registered For ________________________________________

Number of Children _______________