Mommy & Me

Reservation Information

Name/s and age/s of child/ren reserving *

Street Address

City

State

Postal Code

Please let us know a little bit about your child! (Allergies or medical condition?)

How did you find the Mommy & Me program?

First Name

Last Name

Mother's Email *

Mother's Phone *

Father's Name

Father's Phone

Date Attending (for walk-in class)

Reservation Fee(s)

Number of children: Walk-in class

$30.00

Number of children: Fall Session - Oct. 10, 17, 24, 31, Nov. 7, 14

$150.00

Number of children: Winter Session - Dec. 5, 12, 19, 26, Jan. 2, 9

$150.00

Number of children: Spring Session - Feb. 13, 20, 27, March 5, 12

$120.00

Please consider celebrating your child's birthday or any occasion with us!

Sponsorships

Total

My sponsorship is in honor/in memory of