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Mommy & Me

Mommy & Me

Child's Information
Child's Name:
Child's DOB:
Mother's First Name:
Mother's Last Name:
Father's First Name:
Father's Last Name:
Registration Information
I am registering for Tot Shabbat Spring Session  [May 5 - June 2]    
 Entire Session ($75 per session) I will be dropping in ($18/class)
Payment Information
First Name:
Card Type:
Last Name:
Card Number:
Address:
Expiration Date:
City/State/Zip
CVV Security Code:
Email:
Charge Amount:
$ 
Phone:
Comments:

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