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CHIPS Pre-registration application 2024-25
Please note that the CHIPS program is available to
Chelmsford residents only.
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* Indicates required question
Child's Full Name
*
Your answer
Sex
*
Male
Female
Prefer not to say
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian Full Name(s)
*
Your answer
Home Address
*
Your answer
Preferred Phone Number
*
Your answer
Preferred Email
*
Your answer
Have any of your other children attended CHIPS?
Yes
No
Clear selection
Session Preference
*
AM
PM
No preference
Preference for Number of Days
*
2 Days ($120/mo)
3 Days ($175/mo)
4 Days ($230/mo)- four year olds only
First Choice
Second Choice
2 Days ($120/mo)
3 Days ($175/mo)
4 Days ($230/mo)- four year olds only
First Choice
Second Choice
Does/did your child receive Early Intervention services?
*
Yes
No
Does your child have any special needs
*
Yes
No
If yes, please specify:
Your answer
Other comments:
Your answer
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