<p>TODAY’S DATE: WEST CAMPUS Fall 2014 TINY TOTS AND TUNES A MUSIC, “MOMMY” AND ME PROGRAM Birth-3’s Registration Fee $10 </p><p>MOMMY’S NAME MOM’S BDAY:__/__/__ One Card and Adult per child please!</p><p>NAME OF ADULT W/CHILD (if not mom) CHILD’S NAME CHILD’S SEX: M  F </p><p>CHILD’S BIRTHDATE: / / AGE in mos when class starts: </p><p>ADDRESS </p><p>CITY STATE ZIP </p><p>HOME # CELL # </p><p>EMAIL Are you a member of a church? Yes  No  What church? (You do not have to be a member of SBC to participate.)</p><p>Is your child walking yet? Circle One: Yes No</p><p>Name one “Mommy” that you would like to be with: (if possible-classes are split by age)</p><p>Childcare for other siblings available for $10 per family by reservation.**</p><p>Child’s name Birthdate </p><p>Child’s name Birthdate </p><p>?’s contact Cindy Long 713-465-3408 x1005 [email protected]</p><p>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 </p>