JTots!

Full Name*
First Name Last Name
E-mail*
Phone Number*
Child's Name*
First Name Last Name
Child's Age*
Monday Dates

Sep 8, 15, 29

Oct 6, 13, 20, 27

Nov 3, 10, 17, 24

Dec 1, 8, 15

Wednesday Dates

Sep 10, 17

Oct 22, 29

Nov 5, 12, 19, 26

Dec 3, 10, 17
Select day(s)*

Mondays Only - $700 (14 classes)Wednesdays Only - $550 (11 classes)Mondays and Wednesdays - $1,000 (25 classes)
Select time slot*

9:15 - 10:30 AM10:45 - 12:00 PM
Caregiver who will be joining*
First Name Last Name
Any comments or questions?
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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