CDC Application for Admission

CDC Application for Admission
Child's Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Expected Start Date (if newborn)

Month Day Year
Date
Sex *

Male Female
Address *

Street Address

Street Address Line 2

City State

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

Faculty/Staff Member Student None of the Above
YTC Faculty/Staff Department:
YTC Student Major:
Parent/Guardian 1 Name *

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

Street Address

Street Address Line 2

City State / Province

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

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

Street Address

Street Address Line 2

City State / 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

Month Day Year
Date
Application Fee paid on:

Month Day Year
Date
Sibling/Class:
Contact Record:
FORM USE ONLY
FORM USE ONLY2
Should be Empty: