Loved Ones & Me: Inclusive Group Play Date

Loved Ones & Me: Inclusive Group Play Date
Class 1 Schedule
Date - 06/04/2025
Time - 6:00 PM -6:45 PM

Class 2 Schedule
Date - 06/11/205
Time - 6:00 PM- 6:45 PM

Class 3 Schedule
Date - 06/24/2025
Time - 6:00 PM -6:45 PM
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Date

MonthDayYear
Date
Student Information
Name

First NameLast Name
Age
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Level
Write something about yourself
To help us create a comfortable and supportive environment for your child, please share any sensory triggers or specific challenges we should be aware of.
Parent/Guardian Information

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number
Email
example@example.com
Relationship
Other
How do you learn about this Inclusive Play Group?

FacebookTwitterInstagramYouTubeSearch EngineOnline AdsReferralOther
Additional students
Do you want to add enroll more students?

YesNo
Donations

Please note that we are currently offering a few free pilot sessions. While participation is free at this time, donations are always appreciated to help support and grow our program!
Donation
prevnext( X )
Donation
$ Free Quantity

Total

$0.00
Payment Method

CashCredit CardCheckPayPalOther
Please only sign if you're 18 years old and above otherwise, leave it blank and have your parent/guardian signed the next signature field.
Signature of Student
Date Signed

MonthDayYear
Date
Parent/guardian Signature
The relevant links will be provided in the autoresponder email after you successfully registered.

If you have any questions, please email or call us using the details below:

Contact

Loved Ones and nurturingempowment@gmail.com

Tiara (347) 764 4191

Tracey (347) 885 3004

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Loved Ones & Me: Inclusive Group Play Date

Student Information

Parent/Guardian Information

Other

Donations