Parent's Name *

First Name

Last Name

Child's Name *

First Name

Last Name

Child's DOB *

MM

DD

YYYY

Phone Number *

Please provide a number we can text

(###)

###

####

Please indicate which session you are interested in signing up for. (Complete next question if signing up for a single class(es).

Sensory - Full session Tuesdays

Sensory - Full session Wednesdays

Sensory - Full session Thursdays

Sensory - flexible day(s) *Please indicate the dates below*

Music - Full session Tuesdays

Music - Full session Wednesdays

Music- Flexible day(s) *Please indicate the dates below*

Please read and acknowledge *

We will send an email confirmation for the registration.

I've read and acknowledged above