Preschools & 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 |
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Two Year Olds |
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Three Year Olds |
(e.g. Tue & Th 9-11) |
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Four Year Olds |
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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 |
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Three year olds |
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Four year olds |
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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
