Please utilize your "copy & paste" function to access our Enrollment Application, then just print it out & send to:

Winnetuxet Children's Place, Inc.

3 East Street

Halifax, MA 02338

Winnetuxet Children’s Place

Enrollment Application

Child’s Name:__________________________________________

Birth Date:_______________________________________

Parent(s)/Guardian(s):______________________________

Sibling(s)/Age(s): _________________________________

Address:

Street:__________________________________________

City/Town:_______________________________________

Zip Code:_______________________________________

Home Phone:____________________________________

Work Phone:____________________________________

Cell Phone:_____________________________________

Email:_________________________________________

Desired Program:

1^st Choice:_______________________________________

Days (circle choice):___M___T___W___TH___F___

Arrival:_____________Dismissal:____________

2^nd Choice:______________________________________

Days (circle choice):___M___T___W___TH___F___

Arrival:_____________Dismissal:____________

Signature:________________________Date:___________

Name in Print:____________________________________

BE SURE TO INCLUDE YOUR $50.00 Registration Fee

My office door!