CDC Application for Admission

CDC Application for Admission
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Expected Start Date (if newborn)

MonthDayYear
Date
Sex*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Is the Parent a YTC Faculty/Staff Member or Student?*

Faculty/Staff MemberStudentNone of the Above
YTC Faculty/Staff Department:
YTC Student Major:
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Phone Number*
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Phone Numbers
List Previous Child-Care Experience*
What do you hope to gain for yourself and your child from our Child Development Center?*
Submitter's Email*
example@example.com
The non-refundable application fee is $25.00. Please make checks payable to York Technical College and return to the following address:

York Technical College Child Development Center, 452 South Anderson Road, Rock Hill, SC 29730
OFFICE USE ONLY
Date Received

MonthDayYear
Date
Application Fee paid on:

MonthDayYear
Date
Sibling/Class:
Contact Record:
FORM USE ONLY
FORM USE ONLY2
Should be Empty: