Pilgrim Child Care & Preschool 2004 Registration Form
781-934-8145 phone, 781-934-8758, fax
_____ *Full
Year
(September 2004-August 2005)
_____ School Year
(September 2004-June 2005)
_____ *Summer
plus Full Year (July 2004 – August 2005)
*monthly summer fees apply for Preschool/Pre-K special events
Non-Refundable Fee: $25 Application Fee is due with this form
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Child’s Full Name: |
Child’s Date of Birth (D/M/Y) |
Today’s Date: |
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Please rate last year’s experience: 1 2 3 4 5 best |
Home Phone Number:
781
508 |
How did you hear about PCCP? |
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Home Address / Mailing / Include ZIP Code:
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Schedule Request (please circle)
Mo Tu We Th Fr 1stAvailable |
Time Frame Request (circle one)
Half day 8-12 Full day 8-6, 7-5, 7-6 |
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Any notes regarding Schedule Request: |
Time Frame (Other): |
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Your Name:
Relationship to child:
Work Phone #:
Occupation and Town:
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Second Parent / Guardian:
Relationship to child:
Work Phone #:
Occupation and Town: |
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Your Cell Phone: |
Second Parent / Guardian Cell Phone: |
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Your email address: |
Second Parent / Guardian 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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