Kindermusik at Trinity 135 NE Randolph Ave. Peoria, IL 61606 (309) 676-4609 ext. 202 email
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Parental Information
Parent Name(s)
Caregiver’s Name
Mailing Address
City
Zip
E-mail
Home Phone
Work or Cell Phone
Where you heard of us
Select One From The List Below Newspaper Word-of-Mouth Church Newsletter Yellow Pages Other
If Other
Child Information
Child’s Name
Date of Birth
Age
Class
Select One From The List Below Village Our Time Imagine That! Young Child (1,2,4) Sign & Sing Family Time
Day/Time
Sibling childcare is available.
Please call us at 676-4609 (ext. 202) if you have any questions or need assistance.
