Clubhouse Application Form 2024-2025

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If you are interested in enrolling your child, you must submit the Complete Enrollment Application and the Enrollment Deposit $100 to secure a spot in our program or hold a space on our wait list. If your child is placed on the wait list, your deposit will be held until a space becomes available. If you withdraw your child from the wait list before a space becomes available, then your tuition deposit may be refunded, however, you must notify Play Adventures in writing.

CHILD'S INFORMATION:

Full Name

Participants Birth Date *

Does your child have any school or group play experience? *

What stage is your child in toilet training? *

Wears Underwear and never or rarely has accidents

Wears underwear and is completely independent

Wears underwear but needs help with un/dressing or wiping #2

Wears a pull up and is still training

Is in a diaper

Would like to discuss strategies for potty training at home

Does your child attend another school in the area, if so which one?

Do you give Play Adventures permission to share my first name, email, and cell in the school’s family directory (recommended for playdates & forming community)?
*

Yes

Is there anything you would like to share about your child (interests, special needs, allergies)
*

PARENT or GUARDIAN INFORMATION

Full Name

Email *

Phone Number *

Address ( street, city, state, zip ) *

Does participant reside at this address? (If not, Please provide address of participant). *

SECOND PARENT OR GAURDIAN INFORMATION

Full Name

Email *

Phone Number *

Address (street, city, state, zip) *

Emergency Contact 1 (add name, relation and phone number) *

Emergency Contact 2 (add name, relation and phone number) *

Check the Participant Program Options *

Clubhouse Afterschool 2:00PM- 5:30PM $400

Transportation to Our Afterschool $250

half day PM 12-5:30pm ($800)

Other:

Required

Person/s authorized to pick up/drop off your child (name and phone number) *

I will read the Parent Handbook *

Yes, I read, understand, & agree to the Parent Handbook!

Required

If you are interested in enrolling your child, you must submit the Complete Enrollment Application and the Enrollment Deposit $100 to secure a spot in our program or hold a space on our waitlist. If your child is placed on the waitlist, your deposit will be held until a space becomes available. If you withdraw your child from the waitlist before a space becomes available, then your tuition deposit may be refunded, however, you must notify Play Adventures in writing.

(Please Sign and Date)

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