Brookline Recreation Department
Soule Early Childhood Center
652 Hammond St
Brookline, MA 02467
617-739-7598
www.townofbrooklinemass.com/recreation/soule

2007–2008 Soule Center Application

Date of Application: ________________________       Deposit Total: $__________

Please check ALL programs for which you are applying:

PROGRAM NAME

(check)

AGE REQUIREMENTS

Infant / Toddler Program

 

12 months – 2.8 years

Preschool 1 Program

 

2.9 years – 3.8 years

Preschool 2 Program

 

3.9 years – 4.11 years

Preschool Extended Day

 

2.9 years - 4.11 years

Preschool Summer Program

 

For pre-registered preschoolers only

PLEASE NOTE: Your child MUST meet the age requirement for the classroom(s) which you are applying for by September 4, 2007. A copy of your child’s birth certificate is required. Please mail the copy with this application form. Your application WILL NOT be processed without the birth certificate.

A non-refundable deposit of $100.00 per program is required with this application form.

CHILD INFORMATION

Name (first, middle, last):_________________________________________________

Gender: ____ Male ____ Female      Birth Date:________/_________/________

PARENT/GUARDIAN INFORMATION

                                                            Parent/Guardian 1     Parent/Guardian 2

Relationship to Child

 

 

Name

 

 

Address

 

 

Town

 

 

Zip Code

 

 

Day Phone

(       )

(       )

Home Phone

(       )

(       )

Cell Phone

(       )

(       )

Email

 

 

With whom does the child live?: _________________________________________ 

*If sole custody, please provide a copy of the legal agreement

 

*REGISTRATION IS ON A FIRST COME FIRST SERVE BASIS. THERE IS LIMITED SPACE. BE SURE TO RETURN YOUR APPLICATION ASAP.*

Please Mail To:

Brookline Recreation Department

133 Eliot St.

Brookline, MA 02467

ATTN: Soule Center

Include: This application form, a copy of your child's birth certificate, and the non-refundable deposit for each program application.