NECP Application Form 2022-2023
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Newton Early Childhood Program
150 Jackson Rd
Newton, MA 02458
617-559-6050
1.
Child's Name (Last, First, Middle)
*
2.
Gender
*
Female
Male
3.
Date of Birth (MM/DD/YYYY)
*
4.
Primary Language
*
5.
Parent(s)/Guardian(s) Name(s)
*
6.
Full Address (Street, City, Zip)
*
7.
Phone Number
*
8.
Email
*
9.
Has a sibling attended in the past?
*
Has a sibling attended in the past?
*
Yes
No
10.
Sibling Name
11.
Please indicate your preferences
*
First Choice
Second Choice
Third Choice
8:30am-1:30pm 4 days/week (M-T, TH-F) & 8:30am-12:00pm 1 day/week (W)
9:00am-2:00pm 4 days/week (M-T, TH-F) & 9:00am-12:00pm 1 day/week (W)
9:00am-12:00pm Monday-Friday
12.
Has your child attended daycare or preschool previously? If so, where?
13.
Is your child presently receiving any therapeutic services (Speech Therapy, Occupational Therapy, etc.?) If yes, please list.
14.
Is there a history of therapeutic services (Speech Therapy, Occupational Therapy, Physical Therapy, etc.?)
*
15.
How would you describe your child?
*
Yes/No
Comments
socially outgoing
prefers being alone
very quiet and shy
active
overly active
seems happy
stubborn
fussy
independent
sleeps well
restless nights/nightmares
any unusual behaviors (head banging, rocking, etc.)
16.
Additional Comments or Concerns