Mommy & Me Registration Form

First Name

 

E-Mail

Last Name

 

Phone

Child's Name   Child's D.O.B.

 

       
I would like to register for:

Package discount 4 classes = $40

  Drop in - ($15) per class
         
Payment
Please charge my card below.I will pay at the door.    
CC Type   Card Number
Charge Amount   Exp Date
CVV