KTDC Free Programs Registration

Free Childcare Programs Application

Please complete this application to apply for our Early Head Start/Head Start Program or Preschool for All/Prevention programs through Kids Tech Discovery Center. Applications will be reviewed within 2 business days. If you need to speak with a staff member sooner and/or have an urgent matter, please call us at 1.708.201.7300
Child's Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
2nd Child's Name (if applicable)

First NameLast Name
2nd Child's Birth Date (if applicable)

MonthDayYear
How did you hear about our program?
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Primary Phone #
Format: (000) 000-0000.
E-mail
example@example.com
City of residence
Zip Code
Household income
Family size
Are you currently employed?
How soon are you interested in starting
Are you able to transport your child to a center?
Have you been approved for a Child Care Subsidy?
Does your child have a chronic medical condition or health concern? (such as asthma, diabetes, food allergy/intolerance)
Explain here:
Comments/Notes
Should be Empty:

Free Childcare Programs Application