Child's Enrollment Form

Pilgrim Child Care & Preschool (PCCP)

PCCP | PO BOX 121 | DUXBURY, MA 02331

PCCP Children Papers Packet for:

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Dear Parents, Welcome to PCCP. Please complete the enclosed forms for your child's file.

Please send the last 3 pages of this packet to your child’s Pediatrician, especially if your child has an allergy or any health provision. One form is optional for medication; one is for allergies/health provisions; and one for (which each child MUST have on file) is the Physician’s Statement form.

Return this completed packet at least 1 month before your child’s 1st day OR at your earliest convenience. A parent signature is needed on each form.

The PCCP doors control the access requiring a code is entered to unlock the doors. The code is given to parents upon enrollment and parents are asked to limit sharing this code to one alternative pick up person if possible. There is also a bell to ring should for guests and visitors.

If you have any questions about the packet, use of the door code, enrollment, or tuition, please contact either Michelle or Dawn. Thank you.

Michelle L. Manganaro, PCCP Director, 781-934-8145, ext. 211 Email:

Dawn Kerivan, PCCP Financial Coordinator, 781-934-8145, ext. 200 Email:

Form required by: THE COMMONWEALTH OF MASSACHUSETTS Department of Early Education and Care

Child Information

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Parent/Guardian Information

Parent/Guardian Name
Home Address
Physician's Address
Does your child have an Allergy/Special Diets or a Continual Health need?(Required)
Are there any custody agreements, court orders, and restraining orders pertaining to the child?
Are there any other special limitations or concerns the Teachers should know about your child?
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Regulations for licensing require this information to be on the file to address the needs of children while in care.

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Please provide information for children under 3 (marked*) as appropriate to the age of your child.

Developmental History


Eating Habits

Toilet Habits

*What is used at home?

Sleeping Habits

Please note: The American Academy of Pediatrics had determined that placing a baby on his/her back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and unexplained death of a baby one year age. If your child does not usually sleep on his/her back, please contact your pediatrician immediately to discuss the best sleeping position for your baby. Please also take the time to discuss your child's sleeping position with your caregiver.

Social Relationships

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