Somerville Child Care Center Application | Somerville Public Schools

I would like for my child to start in: *

Year

Month

Day

Specify month and year

Are you are a Somerville Public School teacher or an employee of the city of Somerville? *

Please specify position or write "no"

Child Name *

Child Birth Date *

Year

Month

Day

Parent/Guardian Name *

Address

Home Phone Number *

(xxx-xxx-xxxx)

Work Phone Number

(xxx-xxx-xxxx)

Email Address

What days are you interested in? *

Check all that apply

Expected drop-off time: *

(hh:mm am/pm)

Expected pick-up time: *

(hh:mm am/pm)

How did you hear about our Center? *

Information you would like to share about your child:

Date of initial application *

Year

Month

Day