PlayGym with Emily Dzioba
Wednesdays, 7pm to 10pm
July 8, 15, 22, 29, Aug 5

Tuition: $150
Email address *
Name *
Phone Number
Payment Information
Please follow these steps exactly:

1) Once you have submitted this form, your spot in the session will be reserved for one week. (If you have trouble using this online form, please email to secure your registration spot.)

2) Please immediately send the tuition in a check made out to The New Jersey Play Lab to:

The New Jersey Play Lab
c/o Cheryl Katz
27 Longview Rd
Randolph, NJ 07869

Your check must be received within one week of your online registration to secure your spot permanently. You will receive an email when your check is received confirming your spot in the session.

3) If your check is not received within one week of your online registration, you will receive an email letting you know that your name has been removed from the registration to make space for other students to sign up. If there is still space in the session, you are more than welcome to try again.

Thank you for attention to this process.
Never submit passwords through Google Forms.
This form was created inside of