Participant (Child) Full Name
*
First Name
Last Name
Participant Age
*
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Waiver and Release of Liability: By signing below, I acknowledge and agree that I am voluntarily participating in the Mommy and Me class. I understand and accept all risks associated with participation for myself and my child, and release the organizers, instructors, and facility from any and all liability.
Parent/Guardian Signature
*
Date
*
-
Month
-
Day
Year
Date
Class Date
My Products
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10a-12p class
$20.00
$
20.00
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10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
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