Village Tots Enrollment

Village Tots Enrollment

Village Tots Enrollment

Village Tots is a play-based enrichment program designed to support young children’s social, emotional, and creative development through engaging activities such as sensory play, music and movement, art, storytelling, and guided peer interaction. The program provides a structured and supportive environment where children (ages 3-6) can explore, build confidence, and practice important early social skills. Village Tots classes are youth-only, and families do not attend the classes with their children. However, parents and caregivers are welcome to remain in the building and may relax or work in the Parent Café located inside The Village Center during class times. All classes take place at The Village Center at ACTION, Inc., located at 901 Beauty Ave. in Bowling Green, Kentucky. Families may register for a drop-in class, a weekly unlimited pass, or a monthly membership depending on their needs. Space may be limited for some classes, so early registration is encouraged to secure your child’s spot. Children MUST be potty trained to attend. Lunch is not provided as part of the program. If your child plans to attend two classes in one day, please send a packed lunch with them. Food is not typically provided during classes, although an occasional snack may be offered at times. Children may bring a water bottle if desired, though water will also be available as needed and upon request. Classes are supervised by staff and maintain an approximate staff-to-child ratio of 1:12 to ensure a safe and supportive environment. We look forward to welcoming your child to Village Tots and creating a fun space for learning, creativity, and connection.
Child's Name*

First NameLast Name
DOB*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Allergies (if any)
Is there anything we should know to best support your child?*

Difficulty separating from parentsDifficulty following group directionsHigh activity level / difficulty sitting for activitiesSensory sensitivities (noise, textures, etc.)Emotional regulation challenges (big feelings, frustration)Difficulty interacting with peersHistory of aggressive behavior (hitting, biting, etc.)Allergies or medical considerationsNone / No concerns to shareOther
Please feel free to elaborate on the above answers, or share any other ways that we can support your child:
Parent's Name*

First NameLast Name
Parent's Telephone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent's Email Address*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Telephone Number*
Please enter a valid phone number.Format: (000) 000-0000.
By signing below, I acknowledge and agree to the following:

I understand that my child will participate in various activities including social emotional learning activities, arts and crafts, indoor and outdoor play, physical activities, and special events at ACTION Inc Village Tots.

I understand that, while Village Tots Enrichment Program takes reasonable precautions to ensure the safety of all children, accidents and injuries may occur. I voluntarily assume all risks related to my child’s participation in program activities.

I agree to release, waive, and hold harmless Village Tots Enrichment Program and ACTION Inc., its owners, staff, employees, and volunteers from any claims, liabilities, damages, or expenses resulting from injury, illness, or accidents that may occur during my child’s participation in the program, except in cases of gross negligence.

I confirm that my child is physically able to participate in enrichment activities and that I will inform the program of any medical conditions, allergies, or special needs that may affect my child’s participation.

In the event of a medical emergency, I authorize Village Tots Enrichment Program staff to seek medical treatment for my child if I cannot be reached immediately.
Signature*
PHOTO / MEDIA RELEASE FORM

ACTION Inc's Village Tots Enrichment Program

Village Tots Enrichment Program occasionally takes photographs or videos of children participating in activities, events, and learning experiences. These images may be used for educational, communication, or promotional purposes.

I understand that no personal identifying information (such as last names, addresses, or contact information) will be shared publicly without additional consent.

I understand that I may withdraw this permission at any time by submitting a written request to ACTION Inc.
Photo / Media Release*

Yes, I give permissionNo, I do not give permission
Signature*
I understand that Village Tots is a group program and that children are expected to participate in a way that is safe and respectful to others. If my child is unable to participate safely in the group environment, staff may contact me to discuss appropriate supports or early pick-up if necessary.*

Yes
I understand that payment is required to reserve my child’s spot in Village Tots classes. I understand that drop-in classes, weekly passes, and monthly memberships are non-transferable and may be subject to program policies regarding cancellations or schedule changes.*

Yes
I understand that meals are not provided during Village Tots classes. If my child attends two classes in one day, I will provide a packed lunch. I understand that occasional snacks may be offered and that I am responsible for informing staff of any allergies or dietary restrictions.*

Yes
I understand that Village Tots is a youth-only enrichment program and that parents or caregivers do not attend classes with their children. I understand that program staff supervise children during class times and that participation requires children to be able to engage safely in a group setting.*

Yes
I understand that Village Tots is a recreational enrichment program only and is not a therapy service, preschool, school, or educational program. I understand that the activities are designed for fun, social interaction, and creative exploration and are not intended to provide therapy, clinical services, or formal instruction. I understand that classes are not facilitated by a licensed therapist and that participation does not constitute a therapeutic or educational service.*

Yes
I understand that parents or guardians must remain reachable by phone during my child’s class and must pick up their child promptly at the end of the scheduled class time.*

Yes
I understand that children attending Village Tots must be fully potty trained and able to independently use the restroom. I understand that Village Tots staff do not provide diapering or toileting assistance, and that staff will contact a parent or guardian if a toileting accident occurs that requires assistance.*

Yes
How would you like to enroll in Village Tots?*

Single class (Drop-In) $20Weekly Unlimited $100Monthly Membership $200
What classes would you like to attend?*

Tiny Artists (Monday 8:30-11)Feel the Beat (Mondays 12-2:30)Kindness and Community (Wednesdays 8:30-11)Little Chefs (Wednesdays 12-2:30)Tiny Engineers (Fridays 8:30-11)Big Kid Skills (Fridays 12-2:30)

My Products*

*Monthly Membership *BEST VALUE

Unlimited Village Tots classes all month long. Families attending just 3 classes per week already save with the monthly membership compared to paying per class. Perfect for children who plan to attend regularly.

$200.00

Weekly Pass

Attend any Village Tots classes during the week. Great for families who plan to come multiple times.

$ Free

Drop In Class

Attend a single Village Tots class. Perfect if you want to try a class or come occasionally.

$20.00 Quantity

Total

$0.00

Credit Card Details
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Credit Card Number	Security Code
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