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Moms & Tots Drop In - Payment Form
Please verify reCaptcha before submitting the form.
*
First Name:
*
Last Name:
*
Email:
Cell Phone:
Child's Name:
How many sessions?
Please Select One
1 Session ($15.00)
2 Sessions ($30.00)
3 Sessions ($45.00)
4 Sessions ($50.00)
8 Sessions ($90.00)
Would you like to donate to the program? (Donation receipt will be issued)
TOTAL:
Note
: 3% will be added for all credit card transactions. (Payments may also be made by e-transfer to
asamole@aish.com
, or via cheque or cash)
Sat, May 27 2023 7 Sivan 5783