1. Sign Up

Class Information

Location: University Place : Cirque Bridgeport Park Day: Tuesday Class: Mommy/Daddy & Me (2 - 3 1/2 yrs) Time: 4:30-5:00pm Dates: 9/11/18 — 10/16/18 Meetings: 6 Class Price: $76.00

Student Information

*First Name:

Last Name:

Date of Birth: (mm/dd/yy)

Parent/Guardian Contact Information

First Name: Address/P.O.Box: City:

Last Name: Suite or Apt.: (optional)

State: ZIP/Postal Code: Country: Email Address:

Phone #1:

ext.

Phone #2: (optional)

ext.