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Anyone & Me
Tuesday, April 8, 2025
•
10 Nisan 5785
9:30 AM - 10:45 AM
OSR
Register
IF YOU ARE A MEMBER, PLEASE LOGIN.
This will insure proper credit to your account. Login at the top right corner. If you are accessing this form through your phone, click the 3 line menu at the top right corner.
ANYONE AND ME AT MIDWAY
Fall 2025
Wednesdays
October 22-January 28
9:30-10:45
$455
Classes are for children turning 1 by December 2024 , and their adult
There will be no class onNovember 26, December 24, 25, 31
For more information, please contact Sandi Bettan, at 516-433-9120 or midwaynursery@mjc.org
Family Name
IF YOU ARE A MEMBER, PLEASE BE SURE YOU HAVE LOGGED INTO YOUR ACCOUNT BEFORE COMPLETING THIS FORM
Parent/Guardian #2 Name
Child's Name
Child's Birthdate
Telephone
E-mail
Address
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Number of children enrolling ($455 each)
0
1
2
3
4
5
6
7
8
9
10
Allergies or Concerns:
Please use this space to list any allergies as well as any information about your child that we should know.
PHOTO RELEASE
I hereby certify that I am the parent or guardian and do hereby give my consent without reservation to the foregoing on behalf of this person. By entering your name below you are signing the photo release form.
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Thu, May 8 2025 10 Iyyar 5785