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Mommy and Me

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Mom's Name*
First NameLast Name
E-mail*
Phone Number*
Area CodePhone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child's Name*
First NameLast Name
My child's DOB:
MonthDayYear
Full Session:
Yes, I'd like to sign up for the Full Session (6 weeks) - $75
Yes, I'd like to sign up for individual classes - $15/class:
Nov 4 - $15Nov 11 - $15Nov 18 - $15Dec 2 - $15Dec 9 - $15Dec 16 - $15
Birthday 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 - $100
Nov 4Nov 11Nov 18Dec 2Dec 9Dec 16
Total
$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

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