Splat! Registration Form

Splat! Registration

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Thank you for joining us at Splat!
Fill in the form below and click SUBMIT; you will receive an e-mail confirmaton of your registration.

 

All fields with an asterisk (*) are required.

Questions? Contact:

Erica Kalish, Director, Early Childhood Education

305.866.2771 x25

Erika Olmedo, Splat! Instructor

xx

Parent Name(s)*
 
Address*
 
Address 2
 
City*
 
State*
 
Zip Code*
 
Home Phone (xxx-xxx-xxxx)
 
Email*
 
Business Phone: Parent A (xxx-xxx-xxxx)
 
Cell Phone: Parent A (xxx-xxx-xxxx)
 
Business Phone: Parent B (xxx-xxx-xxxx)
 
Cell Phone: Parent B (xxx-xxx-xxxx)
 
Your toddler's FULL name (First & Last Names)*
 
Toddler's birthdate*
 

Sessions:

WINTER:

SPRING:

Mondays

9:00–10:00 am

January 26-March 30

(9 sessions)

No session February 16

 

Mondays

No Classes

 

Wednesdays

10:15–11:15 am

January 28-April 1

(10 sessions)

Wednesdays

10:15–11:15 am

April 15-May 20

(6 sessions)

 
Please register my toddler for:*
 WINTER Mondays (9 sessions) $225
 WINTER Wednesdays (10 sessions) $250
 SPRING Wednesdays (6 sessions) $150
 
Please select a payment method*
Card
Name on Card
Card Number (no spaces)
CVV
Street Address
Zip
Expiration
Total payment:

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move


 

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