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Registration Form


Complete form online OR print, sign, and send it with payment to:
Just Wee Two
382 S. Oyster Bay Rd.
Hicksville, NY 11801
Tel: (516) 433-0003 * Tel: (800) 404-2204 * Fax: (516) 822-1595

Location: Session:

Parent's Name:
Child's Name:
Birth Date: Age in Months:
(at beginning of session)
Telephone:
Email Address:
Address:
City/Town: State: Zip:

Day: 1st Choice: Time: Room #: Fee:
2nd Choice: Time: Room #: Fee:

Payment Type:
Charge Card #: Expiration: CVV:

How did you hear about the Program?
Word of Mouth Re-Register Publication
(please specify publication)
I have read and understand the above information (signature)