Mother Goose Time

Name: Mother Goose Time
Start: 2018-10-17T09:00:00+00:00
End: 2018-10-17T23:30:00+00:00
Location: Daniel Pierce Library

October 17, 2018 @ 9:00 am - 11:30 pm

|Recurring Event (See all)

Child's Name*
First Last
Birthdate*
Age*
Email*
Phone*
Parent/Guardian Name*
First Last
Physical Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Street Address Address Line 2 City State ZIP Code

Complete only if different from physical address.
Emergency Contact Information
If parent cannot be contacted, who should be contacted in case of emergency?
Emergency Contact*
First Last
Emergency Contact Phone*
Program Registration
Please register for one program per child.
Mother Goose Time
12-23 Months
Toddler Time
24-35 Months
Story Hour
3, 4, & 5 Year Olds
This program is open to Tri-Valley residents only.*
- I confirm that I am a resident of the Tri-Valley Central School District.
Phone
This field is for validation purposes and should be left unchanged.