ALL FORMS ARE DUE BY THE SEPTEMBER 8th MEETING. IF YOU CANNOT ATTEND, PLEASE MAIL
THIS FORM IN ADVANCE TO
Megan Zeck, 32281 Redwood Boulevard, Avon
Lake, 44012
Name: _______________________Phone:________________________
Email:_____________________________________________________
*Only
submit one form per family, unless you want multiple playgroups.*
Child’s Name:
__________________________________ Boy___ Girl ___
Child’s Date of
Birth: ___________________ Age:__________________
If necessary, is
a mixed gender group acceptable?
Yes_____ No_____
List names and
ages of siblings that will be attending:_________________
____________________________________________________________________
Day interested
in meeting (circle all that apply):
M T W
TH F S S
Time:
10:00am–12:00pm Yes No
Other time
requested (please specify): ___________________________
(Note: Weekend and evening playgroups are available)
Name of other
member you would like to have in your playgroup:
____________________________________________
If you are a
member of an existing playgroup that is looking to expand, please fill out the
bottom portion. Please list your current
members and ages so we can add to your group appropriately.
Address:__________________________________________________
Child’s Name:
_____________________________ Boy _____ Girl_____
Child’s Date of
Birth: _______________________Age:______________
Day and time
your group meets:_________________________________
Names and ages
of other children in group, including siblings:____________
_________________________________________________________