Parent's Name(s):
Name of Adult Attending:
Address:
City:
State:		Zip:
Home Phone:		Other:Type:
Contact Preference:
Child #1:		DOB:
Child #2:		DOB:
Free Sibling: (under 8 months by 1st day of class)		DOB:
E-Mail:
How did you hear about us ?:		Referred by:
Wait List ok ?	Yes No

Class Code

Fee

1st Choice:

$150

2nd Choice:

Number of Siblings: (Reduced rate for siblings of the first registered child: @ $90 each)

Registration Fee:(New Families: $15, returning families: $5)

Total (confirmed by phone)

I give permission to use my information (photographs, slides ,videos, or name) for the purpose of advertising:

Yes No