CDC Application for Admission

CDC Application for Admission
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expected Start Date (if newborn)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex
Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Is the Parent a YTC Faculty/Staff Member or Student?
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
2 digit month, 2 digit day, 4 digit yearDate
Application Fee paid on:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sibling/Class:
Contact Record:
FORM USE ONLY
FORM USE ONLY2
Should be Empty: