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TO REGISTER, PLEASE SUBMIT THE FORM BELOW

Child's Name: 

Child's Hebrew Name: 

Child's DOB :

Father's Name:  

Mother's Name:

Address:

Telephone: 

Mother's Cell:

Mother's Email:   

Father's Cell: 

Father's Email:  

Please see above for schedule of Mommy & Me sessions

 I'd like to register for a package of 3 sessions of Mommy & Me | $30

I'd like to register for specific sessions | $10 per class 

Session 1 January 17
Session 2 January 24
Session 2 January 31
 


I would like to pay by credit card. 

Card # Expiration Date:

Name of cardholder: 

Billing Address:

I will be paying by check and will mail it to 101 Mamaroneck Ave, Mamaroneck, NY  10543.

By typing my name here I agree to the credit card charge and that the information above is correct.