Child Name and Pronouns *

First Name

Last Name

Child DOB *

MM

DD

YYYY

Desire Drop In Date(s) *

SAT 7/12 Preschool Play Group @ 511 Rogers

TH 7/17 Toddler Play Group @ 67 Woodhull St

TH 7/24 Toddler Play Group @ 67 Woodhull St

SAT 7/26 Preschool Play Group @ 511 Rogers

TH 7/31 Toddler Play Group @ 67 Woodhull St

TH 8/7 Toddler Play Group @ 67 Woodhull St

SAT 8/9 Preschool Play Group @ 511 Rogers

TH 8/14 Toddler Play Group @ 67 Woodhull St

TH 8/21 Toddler Play Group @ 67 Woodhull St

General Liability Release Waiver *

By filling out the form, I attest to understand that during participation in Collective Kind classes I am responsible for my child’s wellbeing and safety. Furthermore, I agree to release Collective Kind and its employees and will hold them harmless from any liability which may arise from incidents or accidents involving my child/children and myself while participating in Collective Kind classes to the extent allowed by law.

AGREED

Onsite caregiver *

A caregiver is required to stay in for the duration of the playgroup.

AGREED

Household Income *

For equity in access, we charge drop in rates according to HH income

Less than $50K: $20

$50K-$150K: $30

Above $150K: $40