Gather Moms Registration

Name

This address will receive a confirmation email

Phone

Address

Payment

Date(s) of Drop-in

How did you hear about Gather Moms?

Children

If you plan to bring your children, please list below.

Child 1

Age of Child 1

Please note any allergies:

Child 2

Age of Child 2

Please note any allergies:

Child 3

Age of Child 3

Please note any allergies:

Child 4

Age of Child 4

Please note any allergies:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Welcome to Gather Moms! Please fill out all fields in this form as accurately as possible. Our schedule is as follows.

Fall semester - Begins with a kick-off event on Monday, August 12th.

Our first lesson will begin Monday, September 16th.

Spring Semester - Begins
Monday, January 6th.

Please choose the payment that reflects your desired enrollment option from the drop down menu below. We look forward to seeing you!

Gather Moms Registration

Description

Please Fix the Following