Caregiver's Name *

First Name

Last Name

Caregiver's Phone Number *

(###)

###

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Student's Name *

First Name

Last Name

*

Payment is non-refundable and non-transferable to other classes offered by Playgrounded. Student cancellations or missed classes will not be subject to a refund or credit of any kind. Playgrounded reserves the right to photograph or video class for publicity and teaching purposes. Finally, Playgrounded is not responsible for injury during the participation of this class.