Yes! I'd like to Register for Mommy & Me!
Mother's Last Name   First Name

Father's Last Name   First Name

Child's Name   Session
Registration

Fall Session (4 classes $20) I will drop in (1 class $5)

Child's Birthday //
mm dd yyyy		   Total to Charge: 

$

Address

  CC Type
City/State/Zip
City State Zip		   Card #
Phone   Exp. Date
Email   CVV

 

        
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100% of the proceeds of this donation or payment benefit The Shul of Bellaire.