Early Childhood Program Application

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The Hampden-Wilbraham Regional School District is pleased to once again offer integrated early childhood programs for the 2024/2025 school year, consisting of either a morning or an afternoon session for the children of both towns.

Email *

Today's Date: *

YYYY

Student's legal name (Include first, middle and last): *

Student's gender *

Male

Female

Date of Birth: *

YYYY

Place of birth (city, state) *

Address (Include street and town) - student must be listed on town census *

Parent/Guardian name: *

Parent /Guardian telephone #: *

Parent/Guardian e-mail: *

Parent/Guardian name:

Parent/Guardian telephone #:

Parent/guardian e-mail:

Siblings name(s), age(s) and school(s)

Please indicate your choice of program *

Half Day Early Childhood Program (M-F) - Morning Session

Half Day Early Childhood Program (M-F) - Afternoon Session

Either

If the district was able to offer full day, would you be interested? *

Yes

How would you describe your child socially? *

Has a lot of friends

Prefers one or two others

Plays mainly with brothers or sisters

Prefers to play alone

Where does your child like to play? *

Prefers outdoor activities

Prefers indoor activities

Likes both equally

Is your child able to.. *

Dress self completely

Put all clothes on, but is unable to button or zip

Put on easy articles of clothing (e.g. pajamas, coat)

Does your child.. *

Speak clearly most of the time

Have some difficulty making self understood

Struggle to be understood, especially by those outside of family

How does your child communicate? *

Speaks in long sentences and paragraphs

Uses mostly two to three word sentences

Uses mostly single words

Describe your child (check all that apply) *

Friendly

Shy

Cooperative

Independent

Stubborn

Difficult to handle

Required

Which best describes your child? *

Frustrated easily

Extremely quiet

Very easy going, unruffled

Independent, likes his/her own way

Has your child experienced ear infections? *

Yes (infrequent - two to three per year)

Yes (frequent - four or more per year)

Any vision concerns? *

Vision is fine

I question whether my child sees well

Child is under doctor's care

How is your child in new situations or with new people? *

Any previous school experience or early intervention services (if yes, please indicate where or by whom, how long and services received) *

Is there any other information you would like us to know about your child?

Are there any questions we can answer for you?

A copy of your responses will be emailed to the address you provided.

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