Registration Date (YYYY-MM-DD)(required) Mother’s name(required) Mother's surname(required) Father’s name(required) Father’s surname(required) Child’s name(required) Child’s surname(required) Child’s Date of Birth (YYYY-MM-DD)(required) Male/Female (Tick off):(required) Male Female Mom’s cell number(required) Dad’s cell number(required) Mom’s email address(required) Where did you hear about Toddlers’ Workshop? (Tick off)(required) Facebook Internet Friends Word of Mouth Midwife or medical practitioner Other Have you read, and do you accept the Terms and Conditions (pdf/word at the end of this form)?(required) Yes No Do you give consent that photos of your child may be posted on social media (Facebook of Instagram)?(required) Yes No Submit Δ Conditions.pdf Conditions.docx