Weston wing, inc. 2016-2017




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WESTON WING, INC. 2016-2017

313 North Avenue Date of admission: ________

Mailing: P.O. Box 684, Weston, MA 02493 Paid: ___________________

Phone: 781-891-9021, Fax: 781-891-6591 for center use only.

director@westonwing.com

Child’s Full Name_____________________________________________________________

Date of Birth ____________________________ Place of Birth__________________________

Eye color_____________ Hair Color_____________ Sex______ Ethnicity________________

Height _________ Weight _________ Identifying marks _______________________________

Primary Language ____________________Kindergarten entrance age ____________________
ALLERGY INFORMATION_____________________________________________________________
Parent/Guardian Information

Parent/Guardian_______________________ Parent/Guardian _________________________

Home address______________________________ Home Address____________________________

_________________________________________ __________________________________

Home Phone _______________________________ Home Phone _____________________________

Cell Phone _________________________________ Cell Phone _______________________________

Business Phone______________________________ Business Phone____________________________

Occupation_________________________________ Occupation_______________________________

Email(s)_____________________________________________________________________________

How did you hear about Weston Wing? __________________________________________________________
A non-refundable application fee of $60.00 must be included with this form. Please make checks payable to: WESTON WING. Upon the return of this form and the payment of the application fee, your child will be placed on the waitlist. There is a $35.00 charge for each instance of a permanent schedule change to your contracted hours.
I wish to enroll: __________________________________in the preschool/child care program on the following days: (child’s name)
______ Monday Hours _______ to _______

______ Tuesday _______ _______

______ Wednesday _______ _______

______ Thursday _______ _______

______ Friday _______ _______
Parent’s Signature________________________________ Date__________________________
Weston Wing is a private, non-profit corporation that does not discriminate in providing services to children and their families on the basis of race, religion, cultural heritage, national origin, political beliefs, marital status, sexual orientation or disability.


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