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Mom & Tot Registration

Mom & Tot Registration

mommy Banner.jpg

Mother's full name:

Child's full name:

Telephone number:

Email address:

Time choice for upcoming session:
9:15-10:15 (1 yr+)
10:15-11:15 (1 yr+)
9:35-10:15 (infants)
10:35-11:15 (infants)


Donations optional

I would like to give a donation in the amount of: $

Payment: Visa MC

Card number

Exp month and year

Name

Address

City , Province Postal

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