MEEE Program » MEEE Program Application

MEEE Program Application

 

MEEE Logo

 

 

Please indicate the following preference: 

AM (Morning Program), PM (Afternoon Program) 

TIME/DATE STAMP 

AM session: 8:30 AM – 11:00 AM 

PM session: 12:15 PM – 2:45 PM 

pastedGraphic_1.png AM 3’s 

pastedGraphic_1.png PM 4’s & 3’s 

STUDENT INFORMATION 

Child’s Last Name First Name Middle Initial  

Nickname  

Date of Birth  

Child’s Street  

Apt  

City  

State  

Zip  

MOTHER INFORMATION 

Mother’s Name  

Email  

Mother’s Home Phone 

 

Mother’s Work Phone 

 

Mother’s Cell Phone 

 

Mother’s Street  

Apt  

City  

State  

Zip  

FATHER INFORMATION 

Father’s Name  

Email  

Father’s Home Phone 

 

Father’s Work Phone 

 

Father’s Cell Phone 

 

Father’s Street  

Apt  

City  

State  

Zip  

GENERAL INFORMATION 

Do you have concerns about your child’s development?        pastedGraphic_2.pngYes           pastedGraphic_2.pngNo 

 

If YES, please explain:  

   

 

 

Is your child toilet trained?      pastedGraphic_2.pngYes     pastedGraphic_2.pngMost Of The Time (Not at night/Occasional accident)     pastedGraphic_2.pngNo 

 

Please tell us about your child’s play skills with peers: (please check one) 

 

My child avoids peers 

My child has not had many experiences to play with other children 

My child plays alongside peers 

My child plays cooperatively with sibling(s) and peers 

My child has difficulties playing with peers Please explain:  

 

 

 

Please complete other side 

 

 

 

Pre-Academic Skills

 

 

ENROLLMENT CRITERIA 

 

  • Applicant must turn three (3) by September 30th of the school year for which he/she is applying. 

 

  • Parent must provide transportation. 

 

  • Parent to provide all health and immunization records as required by law. 

 

  • Tuition costs as follows: 

                                       ○ 5 days/week          $220/month 

                                       ○ 4 days/week          $180/month 

                                       ○ 3 days/week          $140/month 

                                       ○ 2 days/week          $100/month   

 

I understand the enrollment criteria: 

_________________________________       ___________________ 

                  Parent Signature                                  Date 

 

Jacques Memorial Elementary School, 9 Elm Street, Milford, NH 03055    (603) 673-4434