Child's Name:

Session(s)*:

1= Mondays 9 - 11 ($46 a month, 9 months)
2= Tuesdays 9 - 11 ($46 a month, 9 months)
3= Wednesdays 9 - 11 ($46 a month, 9 months)
4= Thursdays 9 - 11 ($46 a month, 9 months)
5= Fridays 9 - 12 ($61 a month, 9 months)

*$50 Registration Fee due for each session that you register for.

Child's Birthdate:

Allergies:

Address:

City, State, Zip:

Parent Name(s):

Home Phone:

Cell Phone:

e-mail:

Emergency Contact:

Emergency Phone:

After registering, you will be directed to Paypal to pay $50 registration fee for each session. Thank you.