Mommy&Me

Application_Mommy & Me

(600 E 6th Street, New York, NY)

Select Course*

Parent Name (English)*

Parent Name (Korean)

Phone Number (Home)

Phone Number (Cell)*

E-mail*

Address*

Student

Name*

Date of Birth*

Age Group*

Butterfly: 12 to 20 months

Toddler: 21 to 35 months

Class Time *

Allergy

Yes

If yes, please describe (ex. John Jones is allergic to peanuts.)

Miscellaneous Notes

Tuition (12 Classes)

The Payment will be processed safely and easily at Paypal.

We also accept tuition by check. Please print out this page, complete the form, and mail it with your check to

400 Kelby Street, 7th Floor, Fort Lee, NJ 07024. The check should be made payable to NYC Korean School.