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tiny fingers  teach your baby sign language!
Class Registration Form

Parent / Guardian: _____________________________________________________________

Relationship to child: ___________________________________________________________

Address:  ___________________________________________________________________

Email Address: ________________________________________________________________

Phone: home __________________work_________________ mobile______________________

Child’s name: __________________________________________Date of Birth: _____________

Session start date: _____________ Day of week: ________________________Time: _________ 

Location (Check one):   Weekday classes in Springfield ____   Saturday Classes in Alexandria ____
NOTE for allergy sufferers: Classes in Springfield are held in the home of Katherine Diaz.  Katherine 
has two cats in her home.  However, they will not be present during class.  _____Please initial.

Type of Course:
 Baby & Me 6 week  series
Workshop
 Refresher Course 

Materials Fee (see book link)

  
___$90/ 1 adult & child
___$40/ 1 adult & child
___$40/ 1 adult & child

___$25 each book

  
___$140/ 2 adults & child
___$ 75/ 2 adults & child
___$ 75/ 2 adults & child

TOTAL DUE:  _____________

Additional siblings may attend class for half price.  Please list names & birth dates.
_____________________________________________________________________________
 
How did you hear about tiny fingers?  ______________________________________________

Terms:  No refunds can be granted after the first class.  tiny fingers reserves the right to cancel any class which does not meet the minimum enrollment. Out of concern for all children present, PLEASE do not bring a sick child to class.  All missed classes may be made up.  In the event of a closing by Fairfax County Public Schools due to a weather emergency, Tiny Fingers will not hold classes.

Parent/Guardian Signature ______________________________________  Date______________
  
 Please print & complete this form & mail it with a check payable to tiny fingers for the above amount to:
Eileen Ladino
205 Yoakum Parkway  #1803
Alexandria, VA  22304

Confirmation of class registration and directions to our location will be sent via email.