A CHILD'S PLACE
2023-2024 FALL APPLICATION
Date
-
Month
-
Day
Year
Date
CHILD'S NAME
*
First Name
Last Name
BIRTHDATE (INDICATE DUE DATE IF NOT BORN YET)
*
-
Month
-
Day
Year
Date
AGE AS OF 12/31/23
CHILD'S HOME ADDRESS
*
Adding Additional Child or Children?
Yes
No
STATUS OF APPLICANT
Currently enrolled -
Sibling of currently enrolled child(ren)
Alumni child at ACP
Summer Alumni and 22-23 waitlist children
Community applicant
*
PROGRAM INTERESTED IN:
TWOS PROGRAM - 2 BY 12/31/23
THREES PROGRAM - 3 BY 12/31/23
FOURS PROGRAM - 4 BY 12/31/23
DESIRED EXTENDED DAYS:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
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PARENT/GUARDIAN1
First Name
Last Name
PARENT/GUARDIAN1 Email
example@example.com
PLEASE SELECT
Please Select
MOTHER
FATHER
OTHER
PARENT/GUARDIAN1 ADDRESS IF DIFFERENT THEN CHILD'S
PARENT/GUARDIAN2
First Name
Last Name
PARENT/GUARDIAN2 Email
example@example.com
PLEASE SELECT
Please Select
MOTHER
FATHER
OTHER
PARENT/GUARDIAN2 ADDRESS IF DIFFERENT THEN CHILD'S
Should be Empty: