Registration for Groups at My Play Place

Registration for Groups at My Play Place

Please make sure to fill in the required fields and submit this form.
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Language Builders
Ages 2.5-5

Tuesdays 10:30-10:55 AM Birthday Party Room

Supports expressive and receptive language through play, songs, stories and engaging activities.

Free Select Date to Register

Speech Boosters
Ages 3-6

Tuesdays 11:00-11:30 AM

Birthday Party Room

Focuses on practicing common speech sounds through fun, play-based activities.

Free Select Date to Register

Total

$0.00
Participant Name

First NameLast Name
Participant Age AND DOB (MM/DD/YY)
Parent/Guardian Name

First NameLast Name
Parent/Guardian E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
What should we know about the participant? Please list any sensory, speech or behavior related information that would be helpful for us to know.
First-Time Participants ONLY: Did you complete and submit the first-time participant questionnaire located on our website? Questionnaire completion is required before attending a group.
Please check the following to confirm:

I understand that the small groups at My Play Place are designed to promote communication development through play, peer interaction, and parent education. These enrichment programs are not a substitute for individualized speech-language therapy and are not intended to diagnose or treat communication disorders. They are a wonderful complement to speech therapy or a great way to support communication development while families monitor progress or wait for services.
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Registration for Groups at My Play Place

My Products