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Youth Mommy & Me

Mommy & Me Registration 2025

Parents Information
Mother's Name*
First Name Last Name
Mother's E-mail*
Child's Information
Number of Children Registering*
Child's Full Name*
First Name Last Name
Second Child's Full Name
First Name Last Name
Third Child's Full Name
First Name Last Name
Date of Birth*

Month Day Year
Second Child's Date of Birth

Month Day Year
Third Child's Date of Birth

Month Day Year
Payment Information
Cost:

$10/student, $45/session

5 classes per session.

Payment

Credit Card Pay at door

Postal / Zip Code

Country

Amount ($10/class, $45/session)

$10$45
Amount ($20/class, $90/session)

$20$90
Amount ($30/class, $128/session)

$30$128
Should be Empty:

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