Enrollment Form - Play and Grow Early Learning Academy

Enrollment Form - Play and Grow Early Learning Academy

We are accepting applications. Beginning January 2026 you will receive an email updating you on if your application is accepted or denied.
Child's Full Name*

First NameLast Name
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email Address*
example@example.com
Child's Date of Birth*

Date
Parent/Child Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Does your child require any special care or accommodations?*

YesNo
If yes, please describe the special care or accommodations needed*
To help us better understand and support your child's needs, please let us know if your child has ever been asked to leave or been dismissed from a previous childcare program. If yes, please describe and let us know any strategies that were helpful.
Please list any medical conditions, allergies, or special health needs your child has.
Estimated Drop Off Time (Starting at 6:30 AM)*
Estimated Pick Up Time (Ending at 5:30 PM)*
Desired Start Date (Estimated opening March 2026)

MonthDayYear
Date
Enrollment Type*
Should be Empty: