Registration Form for

Music, Stories & Games
Ages 1-5

Saturday Mornings
Mar. 13th - Apr. 17th
9:30 a.m. - 10:15 a.m.

Parent/Guardian Participation Required

Parent/Guardian's Name:
Address:
City, State, Zip:
Phone Number:		E-Mail:
Child's Name:		Birth Date:
Child's Name:		Birth Date:
Child's Name:		Birth Date:
Allergies/Medical Conditions:
Emergency Phone Number: