Summer Plans Before KINDERGARTEN

Scholarship Child Name (First & Last)

Parent / Guardian Name (First & Last)

Confirm Contact Information

Phone

Street Address

City

Zip Code

Confirm Childcare Provider Information

Name of center / provider

Childcare Provider's Email

Childcare Provider's Phone

Current Tuition Rate

Additional Assistance Changes

Does your child receive any additional assistance that we are not currently aware of?

This can include: Child Support, DCF Childcare Subsidy, Discount/Tuition Reduction. Type what kind of assistance and the amount received MONTHLY. If no assistance, type N/A

Summer Plans

Share your child's plans for care during the summer months before school.

This may include: 1) your child attending care at the childcare provider listed above through the summer, 2) changing childcare providers, 3) not remaining in childcare for the summer

Anticipated last day in care before starting Kindergarten

This does NOT need to be set in stone or an exact date. Share your anticipated last day of care. Feel free to explain your situation if needed.

By selecting this checkbox and submitting this form, you are agreeing to the following statement: "I certify that the information listed above is accurate to the best of my knowledge."