Please Print out this form and send it, along with method of payment, to

Mack Parents Center
Jewish Family Service
11223 Cornell Park Drive
Cincinnati, OH 45242

Name
Address
City			State						ZIP
Home Phone	Work Phone						e-mail
Names of children					ages				Birth dates
Program Registration					Number Attending			Names (Ages) of Children
Name		Time	Date		Adult	Child		Participating	Childcare	Fees
Total Class Fees Childcare ($5/hour/child) Total Fees
-Reimbursements cannot be made for missed classes -Refunds given only if classes are filled or cancelled -When classes are free, registration is still needed Childcare must be reserved and paid for in advance Cost: $5 per child per hour -Programs are filled first-come, first-served, based on receipt of registration form and payment -We do not send confirmation				Make Checks Payable to Jewish Family Service JFS accepts VISA, Mastercard, and American Express
				0VISA 0 MC 0 AMEX expiration date:
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				Signature