Tikya Wee Jam

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Wednesday Wee Jam

* First Name

* Last Name

* Email

* Cell

* I am registering

Please Select OneOne ChildTwo Children

* Child's First Name

* Child's Last Name

* Age

* Birthdate (mm/dd/yyyy

Child's First Name

Child's Last Name

Age

Birthdate (mm/dd/yyyy

If you will not be attending the classes with your child, please provide information on the person who will be participating below.

First Name

Last Name

Relationship to child

Cell

* Name on Credit Card

* Billing Address

* City

* State

* Zip

Wed, May 7 2025 9 Iyar 5785