Read & Build with Duplo

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you a member of The Clubhouse?*

How many of your children would you like to register?*

Child 1*

First NameLast Name

Child 1 Current Age*

Child 2*

First NameLast Name

Child 2 Current Age*

Child 3*

First NameLast Name

Child 3 Current Age*

Child 4*

First NameLast Name

Child 4 Current Age*

Child 5*

First NameLast Name

Child 5 Current Age*

Are you planning to attend the mom's fitness class which occurs simultaneously to this Read & Build with Duplo class?*

Which classes are you registering your child(ren) for?*

On what class date will your child(ren) be attending?*

Date

Please choose either the series or the one day only option. Be sure to include all your children that you have listed on this registration in the quantity boxes below.

Read & Build with Duplo - THE FULL SERIES

Registration for this series is non-refundable and non-transferable.

$49.00 Quantity

Read & Build with Duplo - ONE DAY ONLY

Registration for this class is non-refundable and non-transferable.

$10.00 Quantity

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

I understand and agree

I take full responsibility (financially and otherwise) for the medical needs that may arise as a result of my family's participation at The Clubhouse in Holly Hill, including but not limited to allergies, minor first aid issues, accidents, communicable diseases etc. I understand that this event/class will be at a facility with a pool and agree to read and follow all posted signage for my safety.*

I understand and agree

I understand this is a "parent-inclusive" event/class and that I can choose to participate or observe the activity but must remain present and available for the duration. I must be responsible and accountable for all the minors attending with me. I will ensure the minors in my care understand aggressive or crass behavior towards others (both verbal and physical) and breaches to the code of conduct may result in our removal from the event.*

I understand and agree

I understand this is a "parent-inclusive" event/class and that, even though I am attending the fitness class for moms, I must be available as needed for the duration of this class and I may not leave the property. I must be responsible and accountable for all the minors attending with me. I will ensure the minors in my care understand aggressive or crass behavior towards others (both verbal and physical) and breaches to the code of conduct may result in our removal from the event. I understand that I may attend the fitness class as long as my child is settled and capable of engaging on their own.*

I understand and agree

Is there anything you feel is important to communicate to the facilitator of this class? Do you have any specific questions relating to this class?