ROCKVILLE HIGH NURSERY SCHOOL APPLICATION – 18/19

FIRST and LAST NAME OF CHILD________________________________Today’s Date_________

NAME CHILD IS CALLED______________________                      DATE OF BIRTH___/___/____
      		     (child must be three by Dec. 2018)
YEAR ENTERING  KINDERGARTEN    ________                                      Male ____ Female _____

FATHER’S NAME______________________                     MOTHER’S NAME_________________

HOME ADDRESS___________________________________________________________________
TOWN________________________________, CT                     Zip       _______________

HOME PHONE___________________                       PRIMARY CELL PHONE_________________
 FATHER’S PLACE OF EMPLOYMENT______________________            PHONE______________
MOTHER’S PLACE OF EMPLOYMENT_____________________             PHONE______________

EMAIL ADDRESS    ____________________________________________

NUMBER OF SISTERS  ____    AGES_______      NUMBER OF BROTHERS  ____ AGES_______

IS THE CHILD TOILET TRAINED?   					Yes____   No____

DOES THE CHILD UNDERSTAND AND SPEAK ENGLISH?  		Yes_____ No____

PRIMARY LANGUAGE SPOKEN IN THE HOME _______________________ 

ARE YOU ABLE TO PROVIDE TRANSPORTATION FOR THE CHILD? ______ 
(This program cannot provide transportation for children.  Children must be dropped off and picked up at the school at the times specified, there is no “day care” before or after school.)
 
DOES THE CHILD HAVE ANY MEDICAL CONDITIONS WE SHOULD BE AWARE OF?  
If yes, please explain:								Yes_____ No____

DOES THE CHILD HAVE ANY ALLERGIES?  				Yes_____ No ____ 
If yes, please list:

LIST OTHER INFORMATION WE SHOULD KNOW ABOUT YOUR CHILD OR FAMILY SITUATION IN ORDER TO BETTER SERVE YOUR CHILD’S NEEDS:

HOW DID YOU LEARN ABOUT THE PROGRAM? ______________________________________

Please return application ASAP to:   Rockville High Nursery School, Child Development Program, 
70 Loveland Hill Road, Vernon, CT 06066-2399    
DO NOT SEND MONEY WITH THE APPLICATION.

Nursery school continuation is dependent on VPS budget approval without impact to the program.  Notification of acceptance or placement on the waiting list will be communicated to you upon budget approval.  Acceptance is based on number of applicants, their ages and date of receipt.  Younger applicants and/or late applicants will be placed on the program’s waiting list if spaces are filled, please refer to “Description of Program” for details.