Mommy & Me Registration

Mommy & Me will be led by Chaya Mushka Wuensch!
1. Child/ren’s Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Sessions ($15 per session)
Tuesday 12/29Tuesday 1/5Tuesday 1/12Tuesday 1/19Tuesday 1/26
2. Parents information
Phone Number*
Area CodePhone Number

Address*

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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4. Payment Information