Mom's Day Out Enrollment
Email address *
Child's Name *
Your answer
Birthdate *
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Child's Name (2)
Your answer
Birthdate
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Which day are you registering for?
Mom's Name *
Your answer
Phone number *
Your answer
Email *
Your answer
Dad's Name *
Your answer
Phone number *
Your answer
Email
Your answer
Person(s) who will be dropping off and picking up. Please list name and phone number. *
Your answer
Is your child potty trained? *
How did you hear about Mom's Day Out?
Promo Code
Your answer
If you were referred by a friend, who referred you?
Your answer
Monthly Tuition
Tuition rates are as follows:
$90 per month for one child 9 am - 2 pm.

$170 per month for two children (siblings).


Because there is no registration fee, paying your monthly tuition ensures that your child has a spot for the upcoming month. Spots are reserved on a first pay, first served basis. Payment can be made via PayPal to amythayer@gmail.com, by check made out to Amy Thayer, or via Venmo @MomsDayOutUtahCounty. Once you complete this registration form, I will email you to arrange payment.

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