Mommy & Me / Parent Child Registration

Mommy & Me / Parent child

Your Name(Required)

First Last

Your Child's Name(Required)

First Last

Your Child's Date of Birth mm/dd/year(Required)

Your Address

Street Address Address Line 2 City ZIP Code

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Choose a class

Enter Payment

$490 for 14 classes (Sep 10 – Dec 10, no class Nov 25)

Credit Card

Card Details

Cardholder Name

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