2023 APPLICATION FOR
THREES’ PROGRAM

Please complete this form if you are interested in joining our 2022-23 Preschool Program. Children must be three years old and toilet-trained on or before September 1, 2023.

Class Three Registration form 2023.

CHILD INFORMATION

Child’s Name

Sex

DOB

Address

Street Address City ZIP / Postal Code

Name of Parent / Guardian

First

Home Phone

Cell Phone

Email Address

Mother

Father

Both

Other

Name of Parent/ Guardian

Home Phone

Cell Phone

Email Address

Parent/Guardian Marital Status:

Primary Residence:

Languages Spoken at Home:

Name of Church Attended by Parents

Sibling Name

Is your child or their sibling an alumni/student at The P.L.A.Y School / First UMC Preschool, which qualifies them for an alumni discount of $10/month?

Are there any concerns that pertain to your child that may need accommodations or intervention?

TUITION SCHEDULE: I am enrolling my child for the following program (choose one or both options):

Tues/ Thu Class, 8:30 – 12:30 $325/ month - MWF class option is contingent on space determined by VPK enrollment

MEDICAL INFORMATION

I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Doctor:

Address:

Phone:

Dentist:

Address:

Phone:

Hospital Preference:

Please list allergies, special medical or dietary needs, or other information we should know about your child:

EMERGENCY CONTACTS

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent or legal guardian cannot be reached:

Name

Address

Phone #

Name

Address

Phone #

Name

Address

Phone #

Consent

Unless I provide written documentation declining participation in specific, individual activities, I give permission for my child to take part in all school activities and in-house field trips.

I agree to pay a non-refundable annual $150 registration fee in order to reserve my child’s spot at the time of registration.

I agree to pay a one-time, annual supply and activity fee of $150.00 payable on the FIRST day of school.

I agree to pay a monthly tuition fee, from September until May, to be paid by the 5th of each month. I understand there is no allowance made for absences or holidays. There is a late fee of $5.00 on tuition received after the 5th. I understand that I must provide a two weeks written notice of withdrawal from the program. If there is an outstanding balance when my child is withdrawn or completes the year, I will be required to bring my account current

I agree to provide an AM snack and a healthy lunch for my child each school day

I agree to read the parent handbook, containing materials and policies required for Child Care licensing, and comply with the policies included therein.

Florida State Child Care licensing requires all students to have a current physical examination (Form 3040) and immunization record (Form 680 or 681) within 30 days of enrollment. I agree to supply the required medical documentation prior to the start of school and upon expiration.

The P.L.A.Y. School is a 501 (c)(3) nonprofit organization. Donations and corporate partnerships keep our program affordable and allow us to offer scholarships and free parent workshops and family programs and events

If you own or are affiliated with a business or organization and would like to bid on or donate services, be a corporate sponsor/partner, or provide grant funding to The P.L.A.Y. School, please provide the following information:

Name of Business / Organization:

Contact Information:

Type of Assistance:

The P.L.A.Y. School does not discriminate based on disability or any other basis in the enrollment in or access to our services. Financial assistance is available on a sliding scale thanks to generous community donations. Please ask for a Financial Assistance form if you need help with tuition.

The P.L.A.Y. School does not discriminate based on disability or any other basis in the enrollment in or access to our services. Financial assistance is available on a sliding scale thanks to generous community donations. Please ask for a Financial Assistance form if you need help with tuition.

Your signature below indicates that you have read the above items and that the information on this enrollment form is complete and accurate.

Date

Parent’s Signature

Registration Paid

Supply Fee Paid

2023 APPLICATION FOR
THREES’ PROGRAM

Class Three Registration form 2023.

CHILD INFORMATION

TUITION SCHEDULE: I am enrolling my child for the following program (choose one or both options):

MEDICAL INFORMATION

EMERGENCY CONTACTS

The P.L.A.Y. School is a 501 (c)(3) nonprofit organization. Donations and corporate partnerships keep our program affordable and allow us to offer scholarships and free parent workshops and family programs and events

If you own or are affiliated with a business or organization and would like to bid on or donate services, be a corporate sponsor/partner, or provide grant funding to The P.L.A.Y. School, please provide the following information:

The P.L.A.Y. School does not discriminate based on disability or any other basis in the enrollment in or access to our services. Financial assistance is available on a sliding scale thanks to generous community donations. Please ask for a Financial Assistance form if you need help with tuition.

Your signature below indicates that you have read the above items and that the information on this enrollment form is complete and accurate.

Get Started

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2023 APPLICATION FOR THREES’ PROGRAM

Class Three Registration form 2023.

CHILD INFORMATION

TUITION SCHEDULE: I am enrolling my child for the following program (choose one or both options):

MEDICAL INFORMATION

EMERGENCY CONTACTS

The P.L.A.Y. School is a 501 (c)(3) nonprofit organization. Donations and corporate partnerships keep our program affordable and allow us to offer scholarships and free parent workshops and family programs and events

If you own or are affiliated with a business or organization and would like to bid on or donate services, be a corporate sponsor/partner, or provide grant funding to The P.L.A.Y. School, please provide the following information:

The P.L.A.Y. School does not discriminate based on disability or any other basis in the enrollment in or access to our services. Financial assistance is available on a sliding scale thanks to generous community donations. Please ask for a Financial Assistance form if you need help with tuition.

Your signature below indicates that you have read the above items and that the information on this enrollment form is complete and accurate.

Get Started

Follow us on social media

2023 APPLICATION FOR
THREES’ PROGRAM