Mommy & Me

Child's Information
Child's Name:
Child's DOB:
Mother's First Name:
Mother's Last Name:
Father's First Name:
Father's Last Name:
Registration Information
I am registering for Fridays Mommy & Me:
 Full Fall Session ($130)
 Full Winter Session ($180)
 Full Spring Session ($130)
I will be dropping in Fall Class ($20/class) 
I will be dropping in Winter Class ($25/class) 
I will be dropping in Spring Class ($20/class) 
Mommy and Me will be out of session on the following dates:
Fall – Nov. 23 | Winter – Feb. 22 | Spring – April 19, 26
Payment Information
First Name:
Card Type:
Last Name:
Card Number:
Address:
Expiration Date:
City/State/Zip
CVV Security Code:
Email:
Charge Amount:
$ 
Phone:
Comments: