Play and Learn Group Registration Form

Complete the enrollment information and list your first and second choice.  Upon completing this process, you can assume your registration is confirmed. If your first choice is full/closed, you will receive a phone call within 2-3 business days to be offered another group or to be put on a waitlist. Contact 517.244.1267 for questions. 

Parent/Guardian 1 Information
Help for First and Last Name First and Last Name
Help for Street Address Be sure to add the house, building, or apartment number.
Parent/Guardian 2 Information
Help for Street Address Be sure to include the house, building, or apartment number.
Child 1 Information: (under 5 years of age)
Child's Race (select all that apply)
Is your child currently receiving Early On or Great Parents, Great Start (GPGS) services?
Child 2 Information: (under 5 years of age)
Child's Race (select all that apply)
Is your child currently receiving Early On or Great Parents, Great Start (GPGS) services?
Child 3 Information (under 5 years of age)
Is your child receiving Early On or Great Parents, Great Start (GPGS) services?
Child's Race (check all that apply)
Family Information
Choose the school district where you reside.
Where did you hear about our program?
Security Check - To verify you are not a robot, please answer this question:
 


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