Child Development Application Form: 2020-2021

Our Child Development Centers admit students of any race, color, national and ethnic origin to all the rights, privileges, programs & activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national & ethnic origin in administration of its educational policies, admissions policies, scholarship program, athletic & other school-administered programs.

Required at time of enrollment: Certified Birth Certificate (w/ raised seal) and immunization records (waiver must be official document and notarized).

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #2

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #3

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #4

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #5

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Apply For ChildCare

Step 1 of 4

Child Development Application Form: 2020-2021

Child #2

Child #3

Child #4

Child #5

Parent or Primary Care Giver Information #1

Parent or Primary Care Giver Information #2

Additional Contacts Permission Sheet

Ready to take the next step?

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