First 5

Play Pals Enrollment Packet

For children ages 03 – 36 months

and an Adult family member

Robla Preschool

4351 Pinell Street | Sacramento, CA 95838

(916) 927-0136 | Fax(916) 568-7808

The Robla District Play Pals is a free, First 5 funded program.

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To enroll your child, please submit the following to the Preschool Office:

*Complete Application (one application per student

*Housing Questionnaire

*ASQ and ASQ-SE (must be completed first day of class

*First Five Forms

*A copy of your child’s Birth Certificate

*A copy of your child’s Immunization Records (current up to date)

Immunizations needed for Play Pals

Age When Admitted	Number of Doses Required of Each Immunization
2 through 3 Months	1 Polio, 1 DTaP, 1 Hep B, 1 Hib
4 through 5 Months	2 Polio, 2 DTaP, 2 Hep B, 2 Hib
6 through 14 Months	2 Polio, 3 DTaP, 2 Hep B, 2 Hib
15 through 17 Months	3 Polio, 3 DTaP, 2 Hep B, 1 Varicella On or after 1st birthday: 1 Hib*, 1 MMR
18 through 5 years	3 Polio, 4 DTaP, 3 Hep B, 1 Varicella On or after 1st birthday: 1 Hib*, 1 MMR

Come on in!

Have fun learning and playing with your child, and meet new Robla friends!

Play Pals English Application

Play Pals Spanish Application