Are you a mom in need of a break, with newborn to 5th grade kids? Then join us at Countryside 
for Coffee Break, 9:00 - 10:30 am the second Monday of every month. Meet other moms, have a
cup of coffee, do a craft, all while your child is lovingly cared for.

2010 sessions are September 13, October 11, November 8, December 13

Cost is 24.00 for four sessions (September - December)

Here's all you need to do:
 
1. Once you have submitted your form, click the link at the top of your summary to be
    taken to our online banking page where you can pay with Visa, Mastercard or bank transfer
2. On the online banking page, check the box marked "Coffee Break Fall 2010", enter the amount 
    and fill out your personal information (Our online banking is completely secure)
3. You will receive a receipt via email

So Let's get started:

Name
Email Address
Street Address
Phone Number
Birthday

Will you need childcare?N/A
Yes
No
If yes, names and ages of children