2024 APPLICATION FOR
PLay Pals: A Parent-Child PLAY experience for 2-3 year olds

Please complete this form if you are interested in joining our Play Pals Parent Child class. Choose the 6-week sessions you would like to attend. Each 6-week session is $72.

Play Pals Registration Form

Registration form for our Paren-child class for families with 2-3 year olds.

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:

Sibling Name

Is your child or their sibling an alumni/student at The P.L.A.Y School which qualifies them for a sibling discount of 10%?

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):

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 #

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.

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

2024 APPLICATION FOR
PLay Pals: A Parent-Child PLAY experience for 2-3 year olds

Play Pals Registration Form

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:

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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2024 APPLICATION FOR PLay Pals: A Parent-Child PLAY experience for 2-3 year olds

Play Pals Registration Form

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:

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

2024 APPLICATION FOR
PLay Pals: A Parent-Child PLAY experience for 2-3 year olds