A Child's Place 2023-2024 10 MONTH
TWOS, THREES AND FOURS PROGRAMS
A Child's Place, Inc.
90 Hillspoint Road
Westport, CT 06880
, (203) 227-1940
www.a-childs-place.org
Child's Name:
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
Child's Home Address
Town
State
Zip
Primary Contact/Guardian Name:
First Name
Last Name
Primary Contact Role
Please Select
Mother
Father
Other
Primary Contact Email
example@example.com
Primary Contact Phone
Primary Contact Phone Type
Please Select
cell
home
other
Secondary Contact/Guardian Name
First Name
Last Name
Secondary Contact Role
Please Select
Mother
Father
Other
Secondary Contact Email
example@example.com
Secondary Contact Phone
Secondary Contact Phone Type
Please Select
cell
home
other
Twos Program - 2 years by 12/31/23
MON/WED/FRI (9:00 - 12:30)
TUES/THURS (9:00 -12:30)
EXTENDED PLAY (12:30 - 1:30)
Threes Program - 3 years by 12/31/23
MON/WED/FRI (8:45 - 1:00)
MON - FRI (8:45 - 1:00)
EXTENDED PLAY (1:00 - 2:00)
Status of Applicant Applicant Due Date
Currently Enrolled October 11, 2022
Switching between programs or staff children October 14, 2022
Siblings of currently enrolled child(ren) October 18, 2022
Summer Alumni and Waitlist Children October 21, 2022
Community applicant October 24, 2022
Fours Program - 4 years by 12/31/23
MON - FRI (8:45 - 1:30)
EXTENDED PLAY (1:30 - 3:15)
Desired Extended Play Day(s)
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
A Child’s Place has discussed with me their discipline and behavior management policies. I received a written copy of these policies. The policy is available on our website: www.a-childs-place.org
Signed
Clear
Date
*
/
Month
/
Day
Year
Date
A NON-REFUNDABLE APPLICATION FEE OF $75 MUST ACCOMPANY THIS APPLICATION - You will automatically be directed to our website payment page after you submit the application for your convenience.
There is a 2.75% credit card fee. ACH (direct payment) is no charge.
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