Please complete the following form and submit to Judi Schlicting, Director of Enrollment. Judi can be reached in the following ways:

Email             jschlicting@ssdcs.org
Telephone:    781-331-8505, ext. 224
Mail:              200 Middle Street, East Weymouth, MA 02189

Name
Address
Town
Zip
Telephone
E-Mail
Child's Name(s)
Child's Date(s) of Birth
Child's Age(s)
Program(s) Desired
School(s) Child Currently Attends
Parent / Guardian Work Hours
Place of Work
Date needed to start
Family Size
Referral Source