Pilgrim Child Care & Preschool
APPLICATION
781-934-8145 phone * 781-934-8758 fax
Check
all that apply:
_____ Full Year (includes July and August)
_____ School
Year (ends in June)
_____ Summer Camp (July
and August only)
*monthly summer fees apply for Preschool/Pre-K & K special events
*
A Non-Refundable, $25 APPLICATION Fee is due
with this form, and applied to the $100 REGISTRATION Fee upon enrollment. Siblings are waived REGISTRATION fees.
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Child’s Full Name: |
Child’s Date of Birth:
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Today’s Date: |
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How did you hear about PCCP:
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Home Phone Number: |
Half Day
Half Day plus*
Full Day
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Home Address / Mailing / Include ZIP Code:
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Schedule Request (please circle)
Mo Tu We Th Fr
OR 1stAvailable |
Time Frame Request (circle one)
Half day 8-12, 9-1
Full day 8-6, 7-5, 7-6 |
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Notes
re: Schedule: |
*Time Frame (Other): |
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Parent / Guardian:
Relationship to child:
Work Phone #:
Town: |
Second Parent / Guardian:
Relationship to child:
Work Phone #:
Town: |
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Your Cell Phone: |
Second Parent / Guardian Cell Phone: |
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Family Email: |
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Your Signature: |
Date: |
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For
Office Use only: rec’d:
notes: |
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Summer
Classroom:
Fall Classroom: |
Waitlist
Status: |
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Children’s
Papers ______ EA Due Date_________ |
DK
____ MLM ____ |
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