Registration

Child's Name*

Child's Age (in months)*

Child's Birthday*

Siblings' names and ages*

Parent's name (first and last)*

Phone number *

Email address*

What day/time would you like to register? (Please refer to Class Schedule)*

Will a carer other than yourself be attending the class with your child?*Yes
No

If yes, please write the full name and phone number of the parent or carer

Child's allergies or dietary restrictions, if any:*

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