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Play and Learn GRCC Enrollment form

How to participate in Play and Learn GRCC

  • Each child participating enrolls once for the program year, June1 through May 31.
  • A child may attend any Play and Learn GRCC site with a single enrollment.
  • A family with multiple children attending complete the enrollment form for each child through 5 years old.

Play and Learn Spanish Enrollment Form

Spanish Enrollment form instructions:

  1. Download the Play and Learn Spanish Enrollment Form PDF to your computer.
  2. Fill out the form.
  3. Save the form.
  4. Email the form to kathleenneumann@grcc.edu

Play and Learn GRCC Enrollment Form

Child's Information
Required
This field is required
Required
This field is required
Suffix
Required
This field is required
Required
This field is required
Child's Gender Identity
Child's Address
Required
This field is required
Caregiver Information
Required
This field is required
Required
This field is required
Primary Caregiver's Suffix
Required
This field is required
Is the primary caregiver the child's Legal Guardian?
Required
This field is required
Required
This field is required
Required
This field is required
$
Household Primary Language
Required
This field is required
Required
This field is required
What relationship do you have with the child(ren) you bring to Play and Learn. Select all that apply.
Required
This field is required
License/Registration Number
Child Care Providers are eligible to receive training hours that may increase their level of reimbursement. By providing your license/registration number, you are giving GRCC permission to enter your training hours into MiRegistry.
Required
This field is required

Childcare providers must be registered in MiRegistry to receive training hours.

I would like to enroll another child.
Required
This field is required
Second Child's Information
Required
This field is required
Required
This field is required
Suffix
Required
This field is required
Required
This field is required
Child's Gender Identity
Child's Address
Required
This field is required
I would like to enroll another child.
Required
This field is required
Third Child's Information
Required
This field is required
Required
This field is required
Suffix
Required
This field is required
Required
This field is required
Child's Gender Identity
Child's Address
Required
This field is required
Transfer