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

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

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



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


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