Online Registration PCCP Application/Registration Pilgrim Child Care & Preschool Application/RegistrationApplicationNew ApplicationNew Application/SiblingExisting Family Pre-RegistrationTerm you are applying for (check ALL that apply) Summer Term (July & August) Full Year (September - August) School Year (September - June) Child's Date of Birth MM slash DD slash YYYY Requested Start Date MM slash DD slash YYYY Child's Full Name First Last Home PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Summer Time Frame (Number of Hours)Summer Requested (Check All That Apply) Monday Tuesday Wednesday Thursday Friday 1st Available Summer # of days per week012345Half Day (4 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)School Day (7 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)Full Day (10 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)Notes Fall Time Frame (Number of Hours)Fall Requested (Check All That Apply) Monday Tuesday Wednesday Thursday Friday 1st Available Fall # of days per week012345School Day (7 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)Full Day (10 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)Half Day (4 Hours)8:00 - 12:008:30 - 12:309:00 - 1:00Other (Explain in notes)Notes Parent/GuardianParent/Guardian Relationship to Child Cell PhoneWork PhoneFamily Email 2nd Parent/Guardian Relationship to Child Cell PhoneWork PhoneFamily Email Please select one: Application or Registration Payment option: NEW FAMILIES: Pay $25 application fee in order to Waitlist (which is applied to the full $100 registration fee when/if enrolled). New Familes: I agree to pay $25 application fee within 5 days to complete this application Enrolled Families: Please invoice me for $100 Registration fee. This application is not complete if not paid within 30 days. Sibiling: fee is waived Confirmation of summer schedule - no fee needed. Note to Applicant: You will not hear back on your application until/unless there is an opening that matches your application requests noted above. Please review it carefully. If you have questions or wish to follow up on your application, please email Michelle@pccpduxbury.org. I understand this application is not complete if PCCP does not receive the $25 application fee which is deducted from the annual $100 fee when admitted (for new familes) within 5 business days, 2 $25 fee for Summer Only applications within 5 days, or the annual $100 registration fee (for in-house) familes). Upon notification of an opening, space is not reserved without the required deposit.(Required) Yes, I understandI understand that upon admission, a non-refundable tuition deposit is due within 48 hours and is not refundable for any reason.(Required) Yes, I understand Online payment is not available at this time. Please make the check payable to Pilgrim Child Care and Preschool and send it to P.O. Box 121, Duxbury, MA 02331.