Timeless – Play Registration

Let’s rediscover childhood!

Parents, please fill out the form below to register your child(ren) for Timeless Play drop-off play center!

Timeless Play Registration

The Grown-Ups
Parent/Guardian Information
Preferred Family Name:*

How would you like your family to be addressed within our center?
Parent/Guardian Name:*
First Last
Email:*

This is the email we will use to send important account information and center updates.
Cell Phone:*
Work Phone:
Parent/Guardian 2 Name:
First Last
Parent/Guardian 2 Cell Phone:
Parent/Guardian 2 Work Phone:
Home Address*
Street Address Address Line 2 City State ZIP Code
Let's Meet Your Kid(s)!
Tell us about the children you would like to register for Timeless Play. Remember, our center is for children ages 1-12 only.
Child 1 Name:
First Last
Gender:
- Male
- Female
DOB
MM slash DD slash YYYY
Please list any allergies, medical conditions or care needs.
Please list your child's activities, interests and hobbies.
Child 2 Name:
First Last
Gender:
- Male
- Female
DOB
MM slash DD slash YYYY
Please list any allergies, medical conditions or care needs.
Please list your child's activities, interests and hobbies.
Child 3 Name:
First Last
Gender:
- Male
- Female
DOB
MM slash DD slash YYYY
Please list any allergies, medical conditions or care needs.
Please list your child's activities, interests and hobbies.
Child 4 Name:
First Last
Gender:
- Male
- Female
DOB
MM slash DD slash YYYY
Please list any allergies, medical conditions or care needs.
Please list your child's activities, interests and hobbies.
Child 5 Name:
First Last
Gender:
- Male
- Female
DOB
MM slash DD slash YYYY
Please list any allergies, medical conditions or care needs.
Please list your child's activities, interests and hobbies.
Please write any additional children information here.
The Boring Stuff
Are the children you are registering up-to-date on all standard vaccinations?*
- Yes
- No
Proof of vaccinations or a state exemption document will be required before Play Hours may be scheduled. Email a copy of your immunizations to play@trustingconnections.com or upload immunization documentation below.
Immunization Record or Exemption Documentation
Drop files here or

Max. file size: 50 MB.
Are all registered children fully potty trained?*
- Yes
- No
Children do not have to be potty trained to play at Timeless Play. Please explain which children will need diaper changes and/or assistance in the restroom.
Please explain.*
Do we have permission to take photos of your child(ren) in our center for promotional purposes (including but not limited to social media?)*
- Yes
- No
How did you hear about Timeless Play?*

If you heard about us from a Timeless Play member, please write their first and last name here!
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