Please complete this form, print it, and mail with your check,
payable to Vanessa Evans, to:
My Little Lingos
70 Glendale Road, Marblehead, MA 01945

My Little Lingos Registration Application

Name of Child:
Date of Birth:
Address:
Contact Information 1
Parent's Name:
Home Phone: Work: Cell:
E-Mail Address:

Contact Information 2
Parent's Name:
Home Phone: Work: Cell:
E-Mail Address:
Please enroll my child in the following Session at The Marblehead Children's Center
21 Tioga Way, Marblehead, MA 01945

    Session : La Granja (The Farm)July 31 - August 4th, 2017

Please check one of the following Programs:
    3 day program $95 (9:30-noon on Monday, Wednesday, Friday)
    5 day program $145 (9:30-noon on Monday to Friday)

Fees:
    3 day x $ 95 = $  OR  5 day x $145 = $
    be sure to enclose your check payable to Vanessa Evans

Please write any comments in this space:
1.) Review Form. Errors? clicking this button will clear the entire form

2.) Print Form   3.) Sign: __________________________ 4.) Date: ________________
Questions? please email mylittlelingos@gmail.com or call 617-921-7911