Please complete and submit the enrollment forms below (one form per child).
Enrolling* InfantToddlerPreSchool
Desired Enrollment Date*
Name*
Child's Date of Birth*
Parents/Guardians*
Home Address*
Preferred Method of Contact Home PhoneWork PhoneCell PhoneEmail
Home Phone*
Work Phone*
Cell Phone*
Email*
Languages Spoken at Home
Please note medical history/special needs:
Does your child take any medications* YesNo
Health forms are required, complete with all immunization dates and lead test. No child will be allowed to attend until the appropriate health form has been received and processed. Children must have had a physical within 12 months prior to attendance.
Has your child had previous child care (family or center-based) experience?* YesNo
If Yes at:
Additional Comments
How'd You Hear About Us? —Please choose an option—NAEYCInternet SearchWebsiteAdvertisementSocial MediaReferralOther
Upon receipt of this completed Application Form and the $25 non-refundable application fee, your child will be waitlisted. When a space is available, a two-week security deposit will be required. Please mail your application check ( add child name in check memo) to:
FamilyAccess of Newton
Attn: Enrollment
492 Waltham Street, West Newton, MA 02465
