Child Information Form (to be completed ONLY after you are accepted into the program)
2019-2020 Child Information Form - Child information forms must be completed each year and prior to a child's attendance at MAP. They include important information about your child, family contact information, and authorizations.(different from the registration form). They are in a fillable PDF that can be downloaded, completed, saved and emailed directly to your child’s program director. Additionally if your child has an allergy, chronic condition, or will need medication while they are at MAP, we ask that you make an appointment with your child's program director to discuss the issue/concern, drop off medication, and to assure the proper forms are completed (see below).
Additionally, for children in our Jump Start program, families must submit a current physical and complete a Developmental History form and return both to MAP, along with their child information form.
In order to keep children safe at MAP, families with children having a health or medical condition, allergy, who take medicine at home or school, or who may need to have medication at MAP, are required to: contact their child's program director, complete the appropriate plan/forms below, and have it signed by both the child’s licensed health care practitioner and the parent/guardian. Please read through the different descriptions of each form to choose the appropriate form that pertains to your child. If you have any questions, please contact your child’s Program Director.
Meghan Jackson Alex Sakash Kurt Jackson
JS- K-1 Program (508) 359-2165 2-3 Program (508) 359-8513 MAP @ Pfaff Program (508) 359-2168
Meghan.email@example.com Alex.firstname.lastname@example.org email@example.com
Families completing a Sever Allergy Action Plan or an Individual Health Care Plan for their child must set up a time to meet with their child's program director prior to the child's attendance at the program. The purpose of this meeting is to review completed paperwork, drop off & train staff on medication administration (if any), and review health issues/concerns.
Severe Allergy Plan - For all severe allergies which require an antihistamine and/or an EpiPen.
Individual Health Care Plan - For any chronic condition, other than severe allergies, which require medical treatment such as asthma, ADHD, diabetes, epilepsy, and non-severe allergies
Medication Consent Form - For both prescription and non-prescription medications that are NOT necessary for a severe allergy or a chronic condition. (examples: ibuprofen, antibiotics, etc.)
To Register for MAP
MAP Registration forms are available by clicking on them below. In order to register for MAP, families must know their child’s placement/schedule (Preschool—Jump Start or Kindergarten AM, PM or Full Day). Priority is given to families with siblings currently in the program, families currently on the wait list and to those registering before March 15. MAP does its very best to accommodate all families but in some cases, a lottery may necessary.
Jump Start MAP 2019-2020: a program at our North Street/Memorial School location for 4 and 5 year olds not yet in kindergarten, a fun & enriching experience for preschool aged children.
Kindergarten MAP 2019-2020: a program at our North Street/Memorial School location for children enrolled at the Memorial school in half day or full day kindergarten.
Grades 1-6 2019-2020: programming for children in grade 1 attending the Memorial school, children in grades 2 & 3 attending the Wheelock school, and children in grades 4, 5, and 6 attending either the Dale Street school or the Blake Middle School.
After you have mailed your registration form, the Executive Director will confirm your enrollment by asking for a two week refundable tuition deposit. Prior to starting MAP, you will be asked to complete a "Child Information Form" that provides us with contact information, authorized persons that you give permission for us to release your child with, along with emergency contacts and other important information that will help us care for your child. Please feel free to contact Annette Gallagher @ 508.359.0003 or email: firstname.lastname@example.org
Extra Day or Extended Day Form
Use the"Extra Day or Extended Day Form" form to sign up for an extra day or to extend your child's regular day (for Jump Start or AM Kindergarteners). Please consult your child's program director to assure space availability. Click here>> for the extra/extended day form.
MAP requires 2 weeks written notice to make a schedule change (request additional day, drop days, or leave the program). Additional days are subject to space availability. Please email the Executive Director or your Child's Program Director to notify them of the change. Please be sure to notify your child's teacher & school of and schedule changes.
Site Specific Forms for 2nd-3rd Grade Site :
Site Specific Forms for MAP @ the Pfaff Site:
Upcoming Special Sign-up Days:
MAP will be OPEN for the NON SCHOOL DAYS: Monday, September 30 and Wednesday, October 9, 2019 for all children enrolled in grades K-6 from 8:00 a.m. until 6:00 p.m. (*Reminder, not available for Jump Start) In order for your child(ren) to attend, please <<CLICK HERE>>for the sign up form, complete it and return it to MAP along with your payment byFriday, September 13. Families returning their sign ups after this date are subject to space availability as well as a late charge of $10.00.