Playtime registration form
Please bring payment ($80), cash or check, to your first class. Thank you!
Mid-winter special for new families runs from Feb 21 - May 23!
Child's Full Name *
Name child goes by
Gender
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Date of birth
MM
/
DD
/
YYYY
Street address
City
State
Zip code
Mother's full name
Mother's phone #
Mother's email address
Father's full name
Father's phone #
Father's email address
Adult usually attending *
Please list siblings and ages
Any medical concerns or allergies?
Please list any additional information that you think we should know (i.e. special needs, child's fears, etc.)
Please list preferred class time
Clear selection
Submit
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