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Mother's full name:

Child's full name:

Telephone number:

Email address:

Time choice for upcoming summer session:
JULY 27-AUGUSTĀ 17

9:15-10:15 (1 yr+)
10:15-11:15 (1 yr+)
11:15-11:45 (infants)


Donations optional

I would like to give a donation in the amount of: $

Payment: Visa MC

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Exp month and year

Name

Address

City , Province Postal