Scroll down to register.Child's Name*First NameLast NameMy child's DOB:1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearMom's Name*First NameLast NameE-mail*Phone Number*Area CodePhone NumberFull Session:Yes, I'd like to sign up for the Full Session (6 weeks) - $75Yes, I'd like to sign up for individual classes - $15/class:Sept 20th - $15Sept 27th - $15Oct 4th - $15Oct 11th -$15Oct 18 - $15Oct 25th - $15Birthday Sponsors!Celebrate your child's birthday at Mommy & Me! Birthday cake & gift included, and bring along up to two friends for free!Yes, I'd love to sponsor one week's Mommy & Me in honor of my child's birthday - $100Sept 20thSept 27thOct 4thOct 11thOct 18Oct 25thTotal$0.00Yes, I'd like to donate the cost of processing this transaction by adding 3%Payment*Credit Card Paypal Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity Code1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2020202120222023202420252026202720282029Expiration YearPaypal has been selected. Payment will take place on the next page.SubmitShould be Empty: This page uses TLS encryption to keep your data secure.
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