WHC’s Caregiver & Me Playgroup

About this event

REGISTER

Looking to connect with other families, get out of the house and enjoy some quality time with your little one? Join us a fun, relaxed morning for families with children ages 0-3 years old!

When: Wednesdays, 9:30-10:30 am

Where: Julia Bindeman Suburban Center (11810 Falls Road, Potomac, MD 20854)

Session : December 2, 9, and 16

Cost: $10 per child

What to expect:

• Live music and dancing!

• Snacks

• Playtime and opportunities to explore

• A welcoming space to mingle and connect with other families

Come as you are, meet new friends, and let your little ones play and explore together! We can’t wait to welcome you and your little ones!

Questions? Reach out to Caren Pilgermayer, Director of RJW Early Childhood Center, at cpilgermayer@whctemple.org .

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Caregiver & Me Playgroup

CHILD'S INFORMATION

First Name

Middle Name

Last Name

Prefers to be called

Date of Birth

SESSION REGISTRATION

Are you a WHC member? Yes No

I would like to register my child for a session on (Check all that apply): December 2 December 9 December 10

Child will be attending with (Check all that apply) Parent/Guardian 1 Parent/Guardian 2 Additional Caregiver(s)

PARENT / GUARDIAN 1

First Name

Last Name

Email Address

Phone Number

Street Address

City

State Please select... 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip Code

PARENT / GUARDIAN 2

First Name

Last Name

Email Address

Phone Number

Is there an additional address you would like to provide for this parent? Yes No

Street Address

City

State Please select... 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip Code

OTHER CAREGIVERS

First Name

Last Name

Email Address

Phone Number

Relationship to Child

ADDITIONAL INFO

Do you need any accommodations to allow full participation in this class? Yes No

What accommodations do you need?

Snack will be served as part of this program. Does your child have any allergies? Yes No

Please explain the allergies here:

If there's anything else you'd like us to know about your child, please use the space below:

How did you hear about this program? Check all that apply. Digital ad ECC/WHC family Print ad Shalom TV Social media WHC newsletter WHC website Other

Which family?

TOTAL COST

Subtotal

$

Admin Code (Staff Use Only) Please select... No Yes

Enter Admin Code

Amount Due Today

$

Would you like to make a donation to the Lewis S. Wiener Annual Fund supporting the Temple's greatest financial need? Enter the amount below.

$

This donation is from:

Total Amount

$

Refund policy

PAYMENT METHOD

How would you like to pay your bill? Credit Card (includes 3% fee) ACH (Direct Bank Debit - No fee)

CREDIT CARD INFORMATION To help defray some of WHC's credit card processing costs, a 3% fee has been added to your credit card payment. Please note that ACH payments do not include this fee.

Fee Amount

$

Grand Total

$

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Last Name on Card

Credit Card Number

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CVV

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Billing City

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Billing Zip Code

ACH INFORMATION

Bank Routing Number

Bank Account Number

Bank Account Type Checking Savings

Bank Name

Account Holder's Name ( NOTE: If this is a joint account, use one name only. If it's a trust/foundation use one first/last name only )

Different billing address? Please select... No Yes

Billing Street

Billing City

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