Tech 4 Tots Class Registration

Please fill out this form to register your child for Tech 4 Tots.  Email address is required for registration.  Please press the Submit button when complete.

School or Daycare Name: *
1st Child's Full Name: *
1st Child's Age: *
2nd Child's Full Name:
2nd Child's Age:
Parent's Full Name: *
 Home Address:
City:
Zip Code: (5 digits)
Home Phone:
Cell Phone:
Email: *
Comments:

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