Please contact:    Jen Fleischman at  malkalieba@aol.com

Montgomery Moms

     2008-2009 Playgroups

Friendships and support are just the beginning when you join the Montgomery Moms 2008-2009 playgroup program. Playgroups are organized by age categories and, where possible, by geographical convenience. The child’s age as of September 1, 2008 will determine your playgroup category, unless otherwise requested. 

Child’s Name:______________________________Age as of September 1, 2008:________

Mother’s Name:____________________________Child’s Birthday:__________________

Address:_____________________________________________Zip Code:___________

Phone:________________________ Email:___________________________________

Siblings attending and age(s) : _____________________________________________________________________

Preferred day of the week:__________________      2nd Choice:_____________________

Days you cannot attend:___________________________________________________

Do you prefer mornings or afternoons?_________________________________________

Would you like to remain with your playgroup from the previous year? __________

If so, please list playgroup members’ names: ___________________________________

_______________________________________________________________________

Comments/Specific Needs (please include food allergies here): ____________________ ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Send completed form to:        Jennifer Fleishman

                      Any questions, please call 469-1940

I understand that I am responsible for my child’s conduct and safety at all Montgomery Moms activities.

Signed:___________________________________________  Date:___________________