Baby and Me Class Registration and Payment

Baby and Me Class Registration Form

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

MonthDayYear
Date
First and Last Name*

PrefixFirst NameLast 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 EST4 Months and Up: Fridays @ 11:00 am EST0-12 Months: Mondays @ 8:00pm EST
Payment Options:*
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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