Child's Information

First Name 

Last Name

Date of Birth [mm/dd/yyyy]

M  F  

Age 

School Attending 

 

Parent's Information

Parent 1

Parent 2 (if applicable) 

Address

City/State/Zip

Home Phone

Cell Phone

Email

Does your child have any allergies or special needs we should know about? (if none, write none)

Registration 

Karma Kids Yoga ($335.00 per semester)

DIY Toys From the Kitchen ($480 per semester)

Creative Movement ($450.00 per semester)

Where the Wild Things Art ($462 per semester)

Hebrew School Prep ($950.00 per semester)

 

Payement
Visa MC Discover

Card Number

Expiration Date [MM/YY]

CVV Code

If billing address is different from Address above, please fill in billing address and zip code


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