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 24, October 16, November 29?

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