Winter/Spring Classes Began January 30th

On-line Registration

Winter/Spring Semester On-line Registration Form 2012

Please fill out the form below and submit. One of our MAGIC team members will contact you shortly to confirm course availability.

Previously enrolled at MAGIC
Yes No  
Child's name
Birth date
/ /   Age Sex M F
School and/or current program    
Primary Email Address* * required
Home Address
Apt#
City State Zip
Mother's Name
E-mail
Home Phone Work   Cell
Father's Name
E-mail
Home Phone Work Cell
Alternate Address
Emergency Contact    
Phone Cell
Physician's Name
Phone
Participating adult and/or person authorized to pick up child
Known allergies/Physical limitations
What's the best way for us to contact you?
Mother's Email Mother's Phone
Father's Email Father's Phone
Other
Please tell us how you heard about our program
Friend Web Site
NY Family Attended a Birthday Party
Big Apple Parent Other
Epiphany Community Nursery School    
Please tell us if you have a friend that would be interested in receiving information about 74th St. MAGIC
Name
Email
Address
City State Zip
   
PLEASE CHECK APPROPRIATE BOXES
Does your child take any medications regularly?
Yes No  
Name of medication, dosage
Condition medication is for
Are there any allergies or health conditions that we should be aware of?
Yes No  
If yes, please describe
Eyeglasses
(Should they be worn during their lessons?)
Yes No  
Contact lenses
(Should they be worn during their lessons?)
Yes No  
Dental Appliances
Yes No  
If yes, please describe
Hearing Aids
Yes No  
Please list any physical conditions we should be aware of
 
CLASS INFORMATION
 
Age Group
  MAGIC MAKERS, 6-18 months
  MAGIC MAKERS, 18-26 months
  MAGIC MAKERS, 2-3.5 Years
  MAGIC KIDS, 3-8 Years
  CLUB MAGIC, 6 Years - Teens
       
Name of Class
Name of Additional Class
   
PAYMENT INFORMATION
Class Day Time Fee
All MAGIC Classes except "My Own Time" and "Classroom Kids"

MAGIC Classes, First Class Per Week


MAGIC Classes, Additional Class Per Week

















$


$
Preschool Alternatives: My Own Time

Please use Shift Key to select multiple days

 $
Preschool Alternatives: Classroom Kids

Please use Shift Key to select multiple days

 $
Drop-in Class (D)
$
       
Total Due     $
 
       
Name on card Billing Zip Code
   
Card # Security #
   
Exp.Date (Month/Year):
   
I understand and accept all enrollment conditions*
Parent or Guardian Name* Date*
*required
Please email me event information and schedule updates.
       
 
Submitting this registration for classes acknowledges acceptance of all enrollment conditions, payment, refund and insurance policies at 74th St. MAGIC.
© Copyright 2009 - 2010, 74th St. MAGIC
510 East 74th Street, New York, NY 10021 • tel 212.737.2989 • fax 212.737.2993 • email magicinfo@74magic.com