Parent-Child Playgroup Registration | Ashwood Waldorf School

Parent's Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Name*

First Last

Emergency Contact Phone*

Will a different parent/caregiver attend the class?

Yes

No

Other parent/caregiver name*

First Last

Child's name*

Child's date of birth*

Register an additional sibling?

Younger sibling's name

Younger sibling's date of birth

Previous Group Experience

Please describe your child’s prior experience in other playgroups or programs.

Allergies or dietary restrictions

Other information

Please list anything else you want the teacher to know about your child

Choose your session(s)*

Session II (Oct 26 – Dec 7) $185

Session III (Jan 4 – Feb 1) $155

Session IV (Apr 4 – May 30) $250)

Fee

Subtotal

$0.00

Sibling Discount

Siblings can attend for half of the regular tuition.

$0.00

Total

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.