Enrollment Application | Little Discoveries

Welcome to the Little Discoveries family!

This intake form helps us get to know your child, who they are, how they learn, and how we can support a positive transition into our program. This form is required for all families and will be reviewed as part of our intake process. Please note: Completion of this form does not guarantee enrollment. Admissions decisions are based on group dynamics, capacity, and the ability to support your child safely and successfully. We are committed to inclusive and non-discriminatory practices, and we do not make decisions based on disability, diagnosis, race, gender, religion, or family background.

Full Name of child *

Preferred Name or Nickname

Nickname (Optional)

Date of birth *

yyyy-mm-dd

Desired Start Date *

Date

Preferred Schedule *

Full Time (Monday–Friday)

Part Time (Monday, Wednesday, Friday)

Part Time (Tuesday and Thursday)

Preferred Location *

522 West Chestnut Street, Brockton

125 Highland Street, East Bridgewater

Either one

Parent/Guardian 1 Full Name *

Full Name

Parent/Guardian 1 Phone *

Phone no.

Parent/Guardian 1 Email

[email protected]

Primary Language Spoken at Home *

Sibling 1 Name & Age

Sibling 2 Name & Age

Sibling 3 Name & Age

Sibling 4 Name & Age

What does a typical day look like for your child?

What helps your child feel safe and comfortable in new environments?

Does your child nap regularly?

Yes

Sometimes

Nap Details *

(time & length, special blanket, pacifier, etc.)

Allergies, dietary needs, or medical conditions we should know about? *

Has your child received any developmental screenings or evaluations?

Yes

I'm not sure

If yes: File upload field for optional IEP, IFSP, or evaluation documents

Upload your document here

Has your child received or been referred for support services (e.g., speech, OT, ABA)? *

Yes

Prefer not to say

If yes: Brief description *

What strategies or supports help your child succeed in group settings?

Are there any behaviors that may impact your child’s or others’ safety?

Yes

If yes: Describe

How does your child respond to new environments or caregivers?

Adjusts quickly

Needs support at first

Often struggles with change

Anything else you’d like to share to help your child succeed?

Previous Program or Provider

Contact Person

Phone Number

Please enter a valid phone number

Email of previous provider

[email protected]

I give permission for Little Discoveries to contact my child’s former provider(s) for collaboration purposes.

Yes

Please read and acknowledge:

I understand that this form is part of Little Discoveries’ intake process and that completion does not guarantee enrollment.

I acknowledge that enrollment decisions are based on safety, group dynamics, staffing, and program fit. I understand that Little Discoveries does not make decisions based on disability, race, religion, gender, or diagnosis and complies with all ADA and EEC regulations.

Signature

Clear

Click on the "SUBMIT" button below to join the little discoveries waitlist