Family Commitment Form
Join Play Smart Literacy to build language and relationships through play!
Sign in to Google to save your progress. Learn more
Parent/Caregiver's first and last name *
Child's first and last name: *
Please list the site you are registering from. *
Your e-mail address: *
Please provide your street address in case we can mail materials
Your zip code
Please check your relationship to the child
Clear selection
How many 0-5 year old children do you have?
Is your baby or child currently enrolled in an early learning program:  (Please check all that apply)
Name of Pre-K or Daycare
#TalkandPlay Agreement
For the next 3 months, we agree to have 10-minute Play Smart Play Dates together at home. *
For the next 3 months, we agree to complete the 2-minute online Play Smart Play Check after each Play Date.   *
My cell phone number: *
You will receive the following free resources to enjoy as you #TalkandPlay at home.  Click one you are most excited to use: *
Please sign our PHOTO CONSENT so we can inspire the rest of the Play Smart community.
By checking the box, you agree that:  "I give permission for me and/or my child/children to be photographed and consent to the use of these photographs and/or videos by Play Smart Literacy, without compensation to me, in ways Play Smart may deem necessary and appropriate to promote the program and its purposes and goals. Please check box(es) to indicate your permission. If no checks are made in this section, we will assume your completion of this form grants us permission for all uses." *
Please complete the following short Pre-Play Family Survey:
Congratulations to our newest PlaySmart Family!  If you take a photo with your child now and tag our instagram @playsmartliteracy with #TalkandPlay you will receive an extra five engagement points!
#TalkandPlay is an awesome way to bring even more fun and love into your family! By working to meet this goal you are boosting your young child’s/children’s brain development. We are so excited to support you as we #TalkandPlay together! DONT FORGET TO CLICK "SUBMIT" TO FINISH!
Clear form
Never submit passwords through Google Forms.
This form was created inside of Play Smart Literacy. Report Abuse