Naya Nature Enrollment Form: PARENT-TODDLER COACHING / PARENT-CHILD CLASSES 1 Information about yourself2 Children you want to enroll3 Your programme 4 Email address* First name*Family name*Phone 1*Phone 2Address* Street Address Address Line 2 City ZIP / Postal Code How did you discover us? School Search engine Social media Family / friends Conference Flyer / Leaflet OtherPlease specify: 1st child to enrollFirst name*Family name*Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Naya Nature is open to children from 2 to 12 yrs.What school does your child attend (if any)?*Do you want to add a second child?YesNoSecond child to enrollFirst name*Family name*Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What school does your child attend (if any)?* Your programme(s)Mini Buffalo: Parent-toddler coaching, for children aged 1,5 to 4 Marmoset: Parent-Child classes on Saturday 10:30-11:50, for children aged 4 to 7Select your package:*1st Discovery session - 7€Card Marmoset 3 sessions in a row - 52€Card Marmoset 5 sessions in a row - 75€Card Mini Buffalo 3 sessions 59€Card Mini Buffalo 5 sessions 79€Registration fees per new enrolment in the school year* Price: 7,00 € Valid from the term "Daffodil" 1 child + 1 parent = 1 enrolmentPlease indicate the date you would like to startMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920You can check here our Agenda Early bird discount -10%*Early bird discount -37,60€Enrolment before February 25th (non applicable for discovery sessions)Who will attend with your child / children?* You Another personWhat is your size of pants?*MLXLXXLI want to bring my own rain pants at every sessionfor rain pantsName of accompanying adult* First Last Link with the child / children*Express who is this person to your child: mother, father, step parent, babysitter... Total estimated per enrolment: 0,00 € 1 child + 1 parent = 1 enrolment and 1 card Nota: This is not an online sales website. By submitting this form, you are simply indicating your interest in our programme.I have a voucher or a special discount I have a voucher or a special discountVoucher or special discount: please note your code here:*The corresponding discount will be computed on your invoice. 1 voucher valid for 1 child enroled.Do you have another voucher or special discount: please note your code here:The corresponding discount will be computed on your invoice. 1 voucher valid for 1 child enroled.General terms and conditions* I have read and accept the General terms and conditions Nota: This is not an online sales website. By submitting this form, you are simply indicating your interest in our programme.Picture and video Policy* I have read and accept the Picture and video Policy In case you don't fully agree with our Picture and video Policy, please let us know, by writing a note in this form or by email.Do you want to leave us a comment?Our sessions are led in English and our Nature Mediators speak many different languages. If you want to precise a favorite language for your child, you can write it here!First ChoiceSending the form generates an automatic subscription to our newsletter Mailchimp (3-4 issues per year - only your name and city are kept in this list). You can unsubscribe from this list at any time by email firstname.lastname@example.org or via the link at the end of each newsletter.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.