Parent & Teacher ResourcesPreschools & Daycare Submission Form

Licensed Nursery Schools & Licensed Daycare Providers print out the form below if you would like to be added to our database.

 

SUBMISSION FORM

for

LICENSED NURSERY SCHOOLS AND LICENSED DAYCARE PROVIDERS

Please type or print. This information will be used for the licensed nursery school and licensed daycare providers’ database on the library’s website and in print format. The library reserves the right to either accept or reject information based on its established policies.

NAME OF SCHOOL: ___________________________________________

ADDRESS:____________________________________________________

PHONE:_______________________FAX:___________________________

WEB ADDRESS:_____________________EMAIL: ___________________

DIRECTOR’S NAME: ___________________________________________

DIRECTOR’S CREDENTIALS: ___________________________________

______________________________________________________________

ARE STAFF CPR CERTIFIED?  YES_____  NO_____

IS THE ORGANIZATION NAEYC ACCREDITED?  YES _____  NO _____

GENERAL DAYS AND HOURS OF OPERATION:                                             

(e.g. M-F. 6-6)______________________________________________

PROGRAMS AVALIABLE

YES

NO

SPECIFIC DAYS & HOURS OF PROGRAMS

3 month – 1 year olds

Two Year Olds

Three Year Olds

(e.g. Tue & Th 9-11)

Four Year Olds

Other

 REQUIREMENTS (INTERVIEWS, TOILET TRAINING, OTHERS):

 REGISTRATION DEADLINE:

 FEES (PLEASE INDICATE WHETHER PER SCHOOL YEAR OR MONTH):

 CHILD TO TEACHER RATIO:

PROGRAMS AVALIABLE

# OF STAFF

# OF CHILDREN

3 month – 1 year olds

e.g. 1

3

Two year olds

Three year olds

Four year olds

Other

 PARENT TEACHER CONFERENCES:

    YES_____ NO_____ HOW OFTEN? _______________________

 PARENT PARTICIPATION PROGRAMS: YES_____ NO_____

    IF YES PLEASE DESCRIBE:

MAY PARENTS VISIT?  YES_____ NO_____ 

    ACCOMPANIED BY CHILD? YES_____ NO_____

ACTIVITIES/EQUIPMENT (PLEASE CHECK THOSE THAT APPLY)

BLOCK AREA

READING AREA

HOUSEKEEPING

AREA

COSTUMES/DRESS-UP

GROSS MOTOR EQUIP.

CIRCLE  TIME/STORYTIME

FREE PLAY

OUTDOOR PLAY

PUPPETS

PUZZLES

GROSS MOTOR EQUIP.

MANIPULATIVE TOYS

PLAY APPARATUS

ARTS/CRAFTS

NATURE STUDY

DAY TRIPS

REST PERIOD

MUSIC PERIOD

VIDEOS/MOVIES

CLASSROOM PETS

COMPUTERS

SNACK

PROVIDED

LUNCH

PROVIDED

OTHER:

Updated: 4/2010

I agree to have the information provided on this form posted on the internet and/or print format.  I understand that the library is not responsible for any changes in the information made by persons who download or transfer the information to their own computers. The library takes no legal responsibility for the accuracy of the information nor for any loss or damage resulting from the use of any such information. An authorized signature is required to post this listing.

Authorized Signature: _____________________________ Date ____________

Name/Title/Phone:_________________________________________________

Please return this form to:

Wethersfield Public Library-Children’s Department, Attn: Brienne

515 Silas Deane Highway, Wethersfield, CT 06109 or fax to 860-257-2822.

If you have any questions please call 860-257-2801.

Updated: 4/2010

 


 

 




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