EmailMe Form - Registration - Summer in Darien

Child's Full Name (First and Last)

Age

Birthday *

MM / DD / YYYY

Please select weeks for this child only

Location:
First Congregational Church of Darien
14 Brookside Rd.
Darien, CT

ROMASHKA 0, 2-3 y.o. 9:30-11:30
TUESDAY, THURSDAY

ROMASHKA 1, 3-4 y.o. 9:30-11:30
TUESDAY, THURSDAY

ROMASHKA 2, 4-5 y.o. 9:30-12:30
MONDAY, WEDNESDAY, FRIDAY

ROMASHKA 2, 4-5 y.o. 9:30-12:30
FULL WEEK, MONDAY-FRIDAY

Please select weeks for this child only

Location:
First Congregational Church
14 Brookside Road
Darien, CT

Play and Learn 0, 2-3 y.o. 4:15-6:15
Tuesdays

Play and Learn 1, 3-4 y.o. 4:00-6:00
Wednesdays

Play and Learn 2, 4-5 y.o. 4:00-6:00
Thursdays

Full Name (first parent or legal guardian) *

Full Name (second parent or legal guardian)

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

### - ### - ####

Work Phone

### - ### - ####

Cell Phone 1

### - ### - ####

Cell Phone 2

### - ### - ####

Email 1 *

Email 2

Additional contact information in case of emergency (phone #, name, relation)

Whom can we thank for recommending us?

Payments for summer program and classes are not refundable. In case any classes or programs are canceled, a pro-rated refund will be issued.

*

I Agree