Registration Form

1. Registration Form Parent’s Name:________________________________________________ Child’s Name:_________________________________________________ Child’s Date of Birth:____________________________________________ Street Address:________________________________________________ City:___________________State: ______________Zip Code:___________ Daytime Phone:________________________________________________ Evening Phone:________________________________________________ E-mail:_______________________________________________________ First Choice for Class:___________________________________________ Second Choice for Class:_________________________________________ This program is intended for both parents and child. The parent is not an observer, but is a participant in all activities, providing supervision and encouragement throughout the class. I understand that Toddlin Time is not to be held responsible for injuries if equipment is used improperly and not as intended. ___________________________________________ Parent or Guardian, Signature You Need to Know Cost: 6 weeks for $55 – Craft classes are 6 weeks for $65 Classes: Meet weekly for 45 minutes – craft classes are for 1 hour Phone: 703-361-5351 Location: 9806 Cockrell Rd. Manassas, VA 20110 (located in the Virginia Dance Center) Mailing Address: Toddlin Time of Manassas P.O. Box 2567 Manassas, VA 20108 Website: www.toddlintimeofmanassas.com