Schedule Appointment with Little Seeds

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First Name *

Last Name *

Phone

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Monthly Open Play	x $35.00	$35.00 per month
Total: $35.00	Coupon:

I consent to the participation of the person in the class or activities and agree on behalf of myself, and/or minor child, that I assume the risk of any injury, accident, injuries or property damage sustained from any cause in connection with my (and/or my child's) participation in the class or activities. I voluntarily release, indemnify, and hold harmless Little Seeds (including its officers, agents, contractors, employees and volunteers) from any liability for any injury, accident, injury or property damage.