Pilgrim Child Care & Preschool APPLICATION / REGISTRATION If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Application type (please check one): * New Application New Application/Sibling Existing Family PreRegistration Term you are applying for (check ALL that apply): * Summer Term (July & August) Full Year (September- August) School Year (September - June) Child's Full Name: * Child's date of birth: * Home Phone: * Street Address: * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Summer # of days per week: 0 1 2 3 4 5 SUMMER Requested (check all that apply): MondayTuesdayWednesdayThursdayFriday1st Available Summer Time Frame (number of hours): Half day (4 hours): 8:00-12:00 8:30-12:30 9:00-1:00 Other (explain in comments below) School day (7 hours): 8:00-3:00 8:30-3:30 9:00-4:00 Other (explain in comments below) Full day (10 hours): 7:00-5:00 7:30-5:30 8:00-6:00 Other (explain in comments below) Summer time frame comments: Fall Requested (check all that apply): MondayTuesdayWednesdayThursdayFriday1st Available Fall # of days per week 0 1 2 3 4 5 Fall Time Frame (number of hours): Half day (4 hours): 8:00-12:00 8:30-12:30 9:00-1:00 Other (explain in comments below) School day (7 hours): 8:00-3:00 8:30-3:30 9:00-4:00 Other (explain in comments below) Full day (10 hours): 7:00-5:00 7:30-5:30 8:00-6:00 Other (explain in comments below) FALL time frame comments: Parent/guardian: * Relationship to child: * Work phone: Cell phone: 2nd Parent/guardian: Relationship to child: Work phone: Cell phone: Family E-mail: * New parents: How did you hear about us? Please select one: Application or Registration Payment Option: * Enrolled Families: Please invoice me for the $100 Registration fee. This application is not complete if not paid within 30 days.Sibling: fee is waived.Confirmation of summer schedule – no fee needed. New Families: I understand this application is not complete if PCCP does not receive the $25 application fee within 5 business days. Upon notification of an opening, space is not reserved without the required deposit. * I understand that upon admission, a non-refundable tuition deposit is due within 48 hours and is not refundable for any reason * Online payment is not available at this time. Please make check payable to Pilgrim Childcare and Preschool and send to 404 Washington St. P.O. Box 121, Duxbury, MA 02331.