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2026 APPLICATION FOR
FOURS’ PROGRAM

Please complete this form if you are interested in joining our 2026-27 Preschool Program. Enrollmen begins January 2026 and requires a signed VPK Voucher to reserve your space. Children must be four and toilet-trained on or before September 1, 2026.

Class Fours Registration form 2026

CHILD INFORMATION

Child’s Name

Sex

DOB

Race

Ethnicity

Address

Street Address City ZIP / Postal Code

Name of Parent / Guardian 1

Full Name

Home Phone

Cell Phone

Email Address(Required)

Custody(Required)

Mother

Father

Both

Other

Name of Parent / Guardian 2

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 an alumni discount of $10/mo for enrichment class?

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

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 #

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

MWF VPK, 8:45AM - 2:00 PM - paid by the VPK voucher

Mo-Fr : Tu/ Th wrap fee, 9:00AM – 2:00 PM $365/mo

M/W/F Private Pay student -$500/mo

Mon - Fri private pay - $800/mo

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.

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

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

I agree to make a one-time, annual, tax-deductible supply and activity donation of $250.00 to The P.L.A.Y. school. Donations of requested cleaning and school supplies equal to the same amount can be given in lieu of the $250.

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

FOR 5-day option with the TUE/TH Wrap class ONLY:

I agree to pay a non-refundable annual $50 registration fee in order to reserve my child’s spot at the time of registration.

I agree to pay an annual tuition, broken down into monthly payments, from August 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 6th of each month. 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.

FOR M/W/F/VPK CLASS:

I agree to receive VPK care Monday, Wednesday, Friday from 8:45 AM – 2:00 PM (staggered start), for a total of 540 hours for the school year, paid by my State of Florida VPK Voucher, and to ensuring that my child regularly and consistently attends school. I understand that the Florida VPK voucher program requires that my child attend school a minimum of 80% of the 540 hours in order for the P.L.A.Y School to be reimbursed for the full voucher amount.

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.

Name

First Last

ADMINISTRATIVE

The P.L.A.Y. School , Inc. is a Florida 501(c)(3) nonprofit corporate, part time preschool serving ages 3-5, offering FREE VPK

School Location: 251 SW 4th Ave.
Boca Raton, FL 33432

Email: Anastasia@theplayschoolpbc.org

Corporate Mailing Address: 2005 N. Swinton Avenue, Delray Beach, FL 33444 EIN 85-0547372

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