INTERACT!                           MOVE!                              ACHIEVE!

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REGISTRATION FORM

 Registration Form

Class sizes are limited.  Play Works! will contact you at the phone number listed below to verify whether there is an opening in the class you requested.  If there is an opening, payment is required to guarantee a spot in the class.  Checks can be made out to: Play Works!.
Please complete the following form. Attach and email it back to us or print it out and submit the completed form to us in person

Name:
Age:
 Parent(s) Names:  
 Address:  
Phone:  
 Email Address
 (used only to communicate about class placement)
 
  Do you have concerns about your child's development?  If so, please describe briefly.  
 How did you find out about us?:  
 Please select your class choice:
 If other, please write in class name.: