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PG Registration Form 2011

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									 Date:__________      Time:__________

 Parent: __________________________________________
 Phone: _______________ Email: ____________________
 Address:_________________________________________

 Child's Name:______________________________________
 Siblings that will also attend:___________________________

             Play Group April 18th - May 27th


Sessions... (Indicate Choice #1 and #2. Put 0 if only one option)



Monday 10-11:30 ______________(18mo-5yr)

Tuesday 9-10:15 ______________(6-24mo)

Tuesday 10:30-11:30 ____________(18mo-5yr)

Wednesday 9-10:15 _________(18mo-5yr)

Wednesday 10:15-11:30_________(18mo-5yr)

* Confirmation of group will be sent by Friday April 8th!

Office use: _______

								
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