Please print this form and return along with your payment and mail to:

$170.00 -  1st Child

$80.00 - sibling over 8 mos old ( under 8mos - Free)

Name of person attending with child(ren):
__________________________________

Relationship to child(ren) (circle one)
Parent/  Grandparent/Nanny/ other__________



Please indicate your 1st and 2nd choice of classes

St. Monica’s Location

Tuesday 10am____   11:15am_____    12:15pm____

Wednesday 10am___   11:15am____     12:15pm___

Thursday 10am___     11:15am___    12:15pm___

Important Policy Information Registration Period: Registration is on a first-come, first-serve basis. Your registration will be confirmed either by phone or e-mail. We cannot guarantee your first choice, but will do our best to honor your request Class Availability: Class schedule may be adjusted due to insufficient registration.

Your First Name:*   Your Last Name:*   Street Address (including apt. number):*   City:*   State/Province:*   Zip/Postal Code:*   Home Phone:*   Work Phone:   Mobile Phone:   Email:* Contact Preference: Email Phone Registrants First Name Last Name Date of Birth (mm/dd/yyyy) Registrant #1 Registrant #2 Registrant #3 Select Semester: Winter 2012 Fall 2011 Default Semester Default Semester Fall 2011 Winter 2012 Class 1st Choice Location: Class Type: St. Monica's Church Mixed Ages Class:* No matching classes were found <Select Location and Class Type first>   Location Class Schedule Start Date Duration Teacher St. Monica's Church Mixed Ages Tuesday 10:00 AM - 10:45 AM Jan 10, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Tuesday 11:15 AM - 12:00 PM Jan 10, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Wednesday 10:00 AM - 10:45 AM Jan 11, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Wednesday 11:15 AM - 12:00 PM Jan 11, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Thursday 10:00 AM - 10:45 AM Jan 12, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Thursday 11:15 AM - 12:00 PM Jan 12, 2012 10 weeks Lisa Herrlich, Teacher, Director         Class 2nd Choice — Please select a second class in case your first choice is unavailable. Location: Class Type: St. Monica's Church Mixed Ages Class: No matching classes were found <Select Location and Class Type first>   Location Class Schedule Start Date Duration Teacher St. Monica's Church Mixed Ages Tuesday 10:00 AM - 10:45 AM Jan 10, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Tuesday 11:15 AM - 12:00 PM Jan 10, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Wednesday 10:00 AM - 10:45 AM Jan 11, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Wednesday 11:15 AM - 12:00 PM Jan 11, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Thursday 10:00 AM - 10:45 AM Jan 12, 2012 10 weeks Lisa Herrlich, Teacher, Director St. Monica's Church Mixed Ages Thursday 11:15 AM - 12:00 PM Jan 12, 2012 10 weeks Lisa Herrlich, Teacher, Director      *  - required fields.