Let’s Play to Learn Registration

Name

Phone Number

Email Address

Mailing Address

What date(s) of Let's Play to Learn do you want to sign up for - September 19, October 28 and/or December 18?

Please provide age(s) of child/ren attending workshop

How did you hear about this workshop?

Do you need childcare? Do you need childcare? Yes No

Child's Name and Date of Birth

Child's Name and Date of Birth

Child's Name and Date of Birth

Child's Name and Date of Birth (If you have more than four children please call to set up childcare.)