Infant/Caregiver Class Registration
Cost is $160 for 8 weeks of class that meets on Tuesdays, 9:30-10:30.
Sign up for FALL class:
September 29, October 6, 20, 27, November 3, 10, 24 and December 1
Sign up for SPRING class:
*
March 2, 9, 16, 23 and April 6, 13, 20 and 27
Child's name: (with twins, list both children's names in the first box (i.e. JackJohn)
*
(First Name)
(Last Name)
Child's birth date:
*
/
Month
/
Day
Year
(Child's Birth Date)
Parent/Guardian name:
*
Cell number:
(Area Code + Number)
Format: (000) 000-0000.
Will you be attending class with your child or will someone else?
*
Yes, me
Someone else
List of name of other person attending:
(First Name)
(Last Name)
Does your child have any ongoing medical problems?
(Medical Problems?)
What topics are you interested in discussing or learning more about? (sleep, nutrition, toilet, child development, etc.)
(Topics?)
Email address of person filling out this form (Form submissions will go to this email and will allow changes to the completed form if need):
*
(example@example.com)
Payment includes processing fee:
*
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One eight week session
You are signing up for the infant/caregiver class that is held one day a week for one hour.
$160.00
$
160.00
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