Circle Which Campus: Woodway

TODAY’S DATE: WEST CAMPUS Fall 2014 TINY TOTS AND TUNES A MUSIC, “MOMMY” AND ME PROGRAM Birth-3’s Registration Fee $10

MOMMY’S NAME MOM’S BDAY:__/__/__ One Card and Adult per child please!

NAME OF ADULT W/CHILD (if not mom) CHILD’S NAME CHILD’S SEX: M  F 

CHILD’S BIRTHDATE: / / AGE in mos when class starts:

ADDRESS

CITY STATE ZIP

HOME # CELL #

EMAIL Are you a member of a church? Yes  No  What church? (You do not have to be a member of SBC to participate.)

Is your child walking yet? Circle One: Yes No

Name one “Mommy” that you would like to be with: (if possible-classes are split by age)

Childcare for other siblings available for $10 per family by reservation.**

Child’s name Birthdate

?’s contact Cindy Long 713-465-3408 x1005 [email protected]

PLEASE RETURN FORM with REGISTRATION FEE TO West : Cindy Long % Second Baptist Church Checks made payable to: 6400 Woodway Second Baptist Church Houston, TX 77057