Single Mom Outreach-Spa Day

August 7, 2010 9AM-2PM

Registration Form

Name

Address

City State Zip Phone

Email Address

1st Child Age Haircut N Y

 List allergies/Medical issues

2nd Child Age Haircut N Y

 List allergies/Medical issues

3rd Child Age Haircut N Y

 List allergies/Medical issues

You may choose up to 3 of the following: (no more than 2 services)

Service-Haircut

Workshop-Parenting Issues

Workshop-Keeping Your House Clean in 15 Minutes a Day

Workshop-Beauty Make-Over - From the Inside Out

Workshop-The Basics of Personal Safety with Self Defense