Early Learning Kit Sign Up Form

Northeast Early Childhood Council (NECC)

Thank you so much for being so interested in the NECC Early Learning Kit, please complete the below form, and we will be in touch with you to confirm your eligibility and arrange drop off of the kit. Please note that we have a limited supply of Early Learning Kits. Any family requesting a kit after supplies have been depleted will be placed on a waitlist, pending future grant funding as well as community donations.

NOTE: Eligibility includes:

1) Have a child age 3 and/or 4 years old (if you have a 2 yr. old turning 3 before 4/30/23, they may be eligible)

2) You must live in one of these towns: Brooklyn, Canterbury, Killingly, Plainfield, Putnam, Sterling & Thompson.

3) Your child must NOT be enrolled in a preschool/school, Head Start, or home visiting program.

Please visit our website to view and/or download a FREE copy of our Regional Resource Guide: www.neccouncil.org.

Due to the volume of requests for Early Learning Kits, please allow us a few weeks to follow up.

Question Title

* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Do you have a child that is 3 or 4 years old (or turning 3 by 4/30/23)

Yes

Question Title

* 3. What is the age of your child

2 (turning 3 by 4/30/23)

Question Title

* 4. Do you have more than one eligible child. If yes, please specify
(ie., twins, a 3 and 4 year old, etc).

Yes

If yes, please specify.

Question Title

* 5. Do you live in the town of Brooklyn, Canterbury, Killingly, Plainfield, Putnam, Thompson, or Sterling?

Yes

Question Title

* 6. What Town do you live in?

Brooklyn

Canterbury

Killingly

Plainfield

Putnam

Sterling

Thompson

Question Title

* 7. Is your child currently enrolled in an early learning program (ie. preschool, headstart, or parent home visiting program)

Yes

Question Title

* 8. If you answered Yes to Question 7, what program are they enrolled in?

Question Title

* 9. How did you hear about us?

Facebook

Flyer

Word of mouth (friend/relative, etc,)

E-mail

Other (please specify)

Early Learning Kit Sign Up Form

Northeast Early Childhood Council (NECC)

Question Title

* 1. Contact Information

Question Title

* 2. Do you have a child that is 3 or 4 years old (or turning 3 by 4/30/23)

Question Title

* 3. What is the age of your child

Question Title

* 4. Do you have more than one eligible child. If yes, please specify (ie., twins, a 3 and 4 year old, etc).

Question Title

* 5. Do you live in the town of Brooklyn, Canterbury, Killingly, Plainfield, Putnam, Thompson, or Sterling?

Question Title

* 6. What Town do you live in?

Question Title

* 7. Is your child currently enrolled in an early learning program (ie. preschool, headstart, or parent home visiting program)

Question Title

* 8. If you answered Yes to Question 7, what program are they enrolled in?

Question Title

* 9. How did you hear about us?

* 4. Do you have more than one eligible child. If yes, please specify
(ie., twins, a 3 and 4 year old, etc).