Form

Baby and Me Class Registration Form

Wendy Rohin, PT ~ Everything Babies LLC
Today's Date

- Month - Day Year
Date
First and Last Name *

Prefix First Name Last Name
E-mail *
What is your baby's Name? (Enter all names for multiples!) *
What is your baby's birthdate? (Actual DOB and due date for preemies!) *
What is your baby's age in months? (Adjusted age for preemies please!) *
Do you have any current concerns or topics you would like to discuss in your class?
Choose Your Class: (Adjusted age for preemies!) *

0-4 Months: Fridays @ 12:00pm EST 4 Months and Up: Fridays @ 11:00 am EST 0-12 Months: Mondays @ 8:00pm EST
Payment Options: *

2-Class Trial Run $ 27.00

8-Class Punch Card $ 97.00

16-Class Punch Card (Save $27!) $ 167.00

Total $ 0.00
Please contact me at wendy@everythingbabies.org if you are having any trouble registering!
IMPORTANT: Please read the payment /cancellation policy and medical disclaimer before submitting.
Click here to acknowledge that you have "read and agree" with the payment/cancellation policy and medical disclaimer provided in the above link. *

Read and Agree
Enter the word(s) as shown to protect your information *
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Baby and Me Class Registration Form