Parent/Guardian Information * First Name Last Name Email * Phone * Country (###) ### #### Emergency Contact #2 First Name Last Name Relationship to Child * Phone * Country (###) ### #### Child Information * First Name Last Name Child's Birthday * MM DD YYYY Which Play Group session(s) would you like to attend? * Our Play Groups are currently Mondays & Wednesdays AM: 09:30 - 11:30 PM: 15:30 - 17:30 *Start time is when doors open, you can arrive at anytime within the play group session* Monday AM Monday PM Wednesday AM Wednesday PM I am not available for the current group times, but please contact me if more days/times become available. What date would you like to start? * MM DD YYYY Which pricing package would you like to buy? * Drop-In Class - 40 EUR 6 Session Bundle - 216 EUR 12 Session Bundle - 385 EUR I would like more information before proceeding Are you able to pay via Bank Transfer to a German Bank Account? * Yes No What languages are spoken in your family? * Does you child have any allergies/dietary restrictions? * If yes, please list. Does your child wear diapers? * Yes No Do you have any development concerns for your child? Are they current receiving any additional services (e.g. Speech Therapy, Occupational Therapy, Physical Therapy, ABA). * If yes, please add additional information. Has your child ever participated in a community group activity with children (e.g. dance class, sports club)? * If yes, describe. Is there any other information that we should know about your child? What is your preferred contact method? * Phone Call WhatsApp Message Email Terms & Agreements * By checking this box, I certify that all the information I have provided above is accurate. I understand that this application does not guarantee admittance to a BLOOM Play Group, and a representative will contact me to answer any follow-up questions and confirm sign-up. I understand that payment is due by the first session that my child attends. Payment can be made via Credit/Debit Card or Cash. I confirm that I will ensure my child brings the following to play group: backpack, diapers, extra change of clothes, water bottle, and inside (house) shoes. I have read and accept the terms of the Privacy Policy (link in Website Footer). Thank you for submitting your application for BLOOM’s Play Group. A representative will be in contact with you as soon as possible to complete your sign-up process. Play Group Application