Tell us a little about you......

Please tell us about you and your child.  We will contact you to confirm your registration for this great program. Space is limited so don't delay.  

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Are you a parent?

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* 5. How many adults will be attending the class?

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* 6. What is your street address?

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* 8. How many children will need childcare?

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* 9. What are the children's name and ages?

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* 10. What school or childcare does your child attend? 

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* 11. Does any one in your group have food allergies or restrictions? if yes explain.

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* 12. What is your email?

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* 13. What is your phone number?

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* 14. What is the best way to contact you?

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* 15. What night are you interested in attending?

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* 16. How did you hear about the program?

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