Parent/Guardian Name * First Name Last Name Email * Phone * Country (###) ### #### Emergency Contact #2 First Name Last Name Relationship to Child * Phone * Country (###) ### #### Child Information * First Name Last Name Child's Birthday * MM DD YYYY Which music group session(s) do you want to attend? * Tiny Tunes (0-15 months) Fridays @ 11:00 Music Movers (2-3 years) Fridays @ 09:30 I am not available for the current group times, but please contact me if more days/times become available. When would you like to start? * MM DD YYYY What languages are spoken in your family? * Do you have any concerns regarding your child? * If yes, please describe: Has your child ever participated in a community group activity with children (e.g. dance class, sports club)? * If yes, please describe: Is there any other information we should know/you would like to share about your child? * What is your preferred contact method? * Phone Call WhatsApp Message Email How did you hear about us? * Google Search Community Flyer Facebook Group Instagram Friend/Family Other Terms & Agreements * By checking this box, I certify that all the information I have provided above is accurate. I understand that this application does not guarantee admittance to a BLOOM Music Group, and a representative will contact me to answer any follow-up questions and confirm sign-up. I understand that payment is due on the first session that my child attends. Payment can be made via Credit/Debit Card or Cash. I confirm that I or a guardian (18+) will participate and attend music class with my child. I have read and accept the terms of the Privacy Policy (link in Website Footer). Thank you! Music Group Application