Registration Form 2019-2020 Tiny Tots
This information will be used to contact you regarding Tiny Tots Co-op member business. Please make sure all your information is current and accurate.
Once your registration is approved as complete, you'll be sent information on payment.
Email *
I am: *
Member Name: *
LAST NAME, FIRST NAME
Telephone Number: *
Mailing Address: *
Address, City, Zip Code
Email Address: *
Email address associated with Facebook, if different (Enables access to Secret Facebook Group):
Partner's Name, (If Applicable) and phone number
First and Last Name of Child and Date of Birth *
Ex: John Doe 1/1/11
Full Name of Child and Date of Birth
Ex: John Doe 1/1/11
Full Name of Child and Date of Birth
Ex: John Doe 1/1/11
Other Adult Family Members/Caregivers who may bring your child(ren) to Tiny Tots and their relationship to the child(ren): (Please include their email addresses to be added to our newsletter and Facebook group, if that is wanted)
I would prefer Tiny Tots contacts me by:
Name of Tiny Tots current member who referred you (if applicable)
How did you hear about Tiny Tots? *
Do you have any special talents/skills/interests (music, dance, art, fundraising, etc.) that you would be willing to share with the Tiny Tots Co-op?
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