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For office use only Received by on Class Registration Form FALL 2011 Card Cash Check Enrolled by on Parent s Name Child s Name Birthdate / / Address Cell Home E-Mail Allergies and/or Medical Conditions Emergency Contact Phone Zimmer Member How did you hear about our classes Credit Card Exp / CVC Please indicate the classes you d like to enroll your child ren Enroll if necessary indicate which child Class Messy Masterpieces A 18 months 3 years Movers Maestros Sensation City Crawlers 24...
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