Registration form for ESL Playgroup

You may use the Translate feature at the bottom of this page to translate this page and print it out.  Or you may view here to print out a copy of this form.

Parent/Caregiver Name:   ____________________________________________________________________                                                                                                                      
My child(ren) will be attending the playgroup with: ________________________________________________

Relationship to Child(ren) (please check one):      Mother    Father           Grandparent          Other Relative         Child Care Provider
Address _________________________________________________           Norwood, MA   02062                               

Phone   _______________________________________        Email      _______________________________________  

Please list ALL children you will be bringing to the group.  If you do not have enough space, please write all the children on the back of this form and note that below.  Thank you!  Children must be 36 mo. (3 yrs.) to 60 mo. (5 yrs.)
Child’s Full Name ___________________________________________Date of Birth _____________________________   
Child’s Full Name ___________________________________________Date of Birth _____________________________   
Emergency Contact:_______________________________ Telephone Number: __________________________________

Do any of the children have special needs or allergies that we should know about?   YES     NO 
If yes, please describe  ______________________________________________________________________________                                                                                                                             
What language(s) do you speak at home?  _____________________________________________________________            
How did you hear about Norwood CFCE Program Playgroup? ______________________________________________
_________________________________________________________________________________________________      

Optional: These questions are so we can report to our funders the number of people who attend our programs who live in subsidized housing or who are currently taking English classes.  The answer you give is confidential and will not affect your placement in a group. 

Do you live in Public Housing, receive Section 8, or some other form of subsidized housing?   YES     NO

Are you currently taking a class to learn English? YES     NO

I have read and I understand the information and agree to follow the rules and guidelines:

Signature:________________________________________________          Date     ___________________                           

Return this form as soon as possible as space is limited to:
Christine Tomasello, Norwood Public Schools, 275 Prospect Street, P.O. Box 67, Norwood, MA 02062.
Forms can also be faxed to (781) 440-5900.  Please fax to the attention of Christine Tomasello.