Child Name

Child Date of Birth

Parent Name

Parent Email

Parent Address

Parent Cell Phone

Emergency Contact Name

Emergency Contact Cell Phone

Any allergies or medical concerns we should be aware of?  If None, please respond NONE

I agree to register my child and myself for the Mommy and Me Tea Pop Up at a cost of $30.00. I understand no refunds or credits will be given for missed classes. An invoice will be emailed to you upon submitting this registration and must be paid to complete registration.

I give permission to seek emergency medical treatment for my child in the event that I cannot be reached.

I give permission to allow my child to be photographed and to allow any pictures in which my child appears to be released for publication in newspapers, brochures, for fundraising or public relations.

I agree to receive emails and SMS messages from Rye Reads Learning Center.

How did you hear about Rye Reads?