Kids korner application
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- Bu səhifədəki naviqasiya:
- Children must be toilet trained. CLASS DESCRIPTION
- LOTTERY REGISTRATION POLICY
- FEE STRUCTURE
- Checks should be made out to the Town of Rocky Hill.
| TOWN OF ROCKY HILL DEPARTMENT OF HUMAN, YOUTH & SENIOR SERVICES KIDS KORNER APPLICATION School Year 2018 - 2019 Revised 11/20/2017
The program will follow (with some exceptions) the Rocky Hill Public School calendar for the 2018-19 school year. It will start after Labor Day in September 2018 and run on Mondays, Tuesdays, Thursdays, and Fridays. This program will be held at the Rocky Hill Community Center. There will be two sessions each day. One morning session for 3 year olds that runs from 9:00 to 11:15 a.m. and one afternoon session that runs from 11:30 to 2:30 p.m. This program is for 4 year olds (must be 3 years of age by 9/31/18). Children must be toilet trained. CLASS DESCRIPTION Kids Korner is designed to provide children, ages 3 to 4, with a comprehensive foundation for ongoing learning. There is an emphasis on social/emotional development, motor development, cognitive and critical thinking. Student learning will be enhanced through a variety of art and nature based activities. LOTTERY & REGISTRATION POLICY Applications will be accepted through January 31, 2018 and may be mailed in or dropped off at the Human Youth & Senior Services office. Names will be chosen randomly to fill spots. If your child has been selected to be in the program, you will be contacted by the middle of February, and offered an opportunity to come in and see the program and meet with the instructors. All applicants that have not been chosen will receive a letter in the mail by the end of February and be placed on our waiting list. Applicants that do not initially get into the program will be put on a waiting list for future openings. The wait list applies to the current year only – a new application must be submitted each year. Please note that additional paperwork, including a health assessment form which needs to be filled out by your doctor, must be submitted if your child is accepted into the program. All forms will be held confidential. FEE STRUCTURE Upon acceptance into the program, a one-time, non-refundable fee of $100 must be paid by May 1, 2018 to secure your spot. The total fee for the duration of this program is $2,400. This fee is broken down into 2 payments of $1,200.The first payment of $1,200 is due July 2 nd . The second payment is due January 1 st .If
payment is not received by the 15 th of the month, a $20.00 late fee will be applied. If your payment is not received by the end of the month, your child will not allowed into the program until full payment is made. Checks should be made out to the Town of Rocky Hill.
Please return completed form to: Cathy Sylvester Human, Youth & Senior Services Department 699 Old Main Street Rocky Hill, CT 06067 Or email completed form to: csylvester@rockyhillct.gov CHILD INFORMATION __________________________________________________________________________________________ First Name
Middle Name
Last Name Date of Birth Gender (Circle One):
Language(s) other than English regularly spoken at home: ___________________________________________ Does anyone else care for your child on a regular basis? ____________________________________________ If yes, please explain who and how often: __________________________________________________ ____________________________________________________________________________________
__________________________________________________________________________________________ Fathers name Mothers name Last name
__________________________________________________________________________________________ Address
City
State Zip Code __________________________________________________________________________________________ Home Phone
Cell Phone
Email Address BROTHERS AND SISTERS NAME
GENDER DATE OF BIRTH SCHOOL GRADE
MEDICAL HISTORY Does your child have any allergies to medications? Circle One: Yes
If yes, please explain medication and reaction: ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Does your child have any additional allergies? Circle One: Yes
If yes, please explain: __________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
DEVELOPMENT HISTORY 1.
Can your child be left alone with a baby-sitter without a big fuss? YES
NO 2.
Does your child have: a.
Problems with eating? YES
NO b.
Problems with sleeping? YES
NO 3.
Is your child a.
Highly active?
YES NO b.
Very quiet?
YES NO
c.
Generally a happy child? YES NO
d.
Unusually shy? YES
NO 4.
Does your child: a.
Cry very easily?
YES NO
b.
Often have temper tantrums? YES NO
c.
Usually follow directions? YES
NO d.
Have a very short attention span? YES
NO e.
Additional comments: ___________________________________________________________ 5.
Is your child a.
Able to speak most sounds correctly? YES
NO b.
Easily understood by other adults?
YES NO c.
Hesitant to speak with other adults? YES
NO d.
Additional comments: ___________________________________________________________ 6.
List your child’s favorite playtime activities: __________________________________________________ _______________________________________________________________________________________ 7.
FREQUENT
OCCASIONAL INFREQUENT 8.
YES
NO 9.
Opportunity to play with children outside of family members: FREQUENT
OCCASIONAL INFREQUENT 10.
YES NO
11.
What words would you use to describe your child? _____________________________________________ _______________________________________________________________________________________ 12.
Is there anything further you wish to mention about your child? ___________________________________ _______________________________________________________________________________________ 13.
Previous nursery school experience: _________________________________________________________ _______________________________________________________________________________________ Report completed by: _________________________________ Relationship to Child: _________________ Signature: __________________________________________ Date: ______________________________ Yüklə 22,58 Kb. Dostları ilə paylaş:
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