A Child's Place
2023-2024 Fives Application
Hillspoint Road, Westport, CT 06880
Date of Birth
Child's Home Address
Primary Contact/Guardian Name
Primary Contact/Guardian Role
Primary Contact/Guardian Email 1
Primary Contact/Guardian Phone 1
Primary Contact/Guardian PhoneType
Secondary Contact/Guardian Name
Secondary Contact/Guardian Role
Secondary Contact/Guardian Email 2
Secondary Contact/Guardian Phone 2
Secondary Contact/Guardian Phone Type
Fives Program - 5 years by 12/31/23
FIVE PART DAYS (8:30 - 2:30)
FIVE FULL DAYS (7:15 - 6:00)
EXTENDED PLAY FOR PART DAY CHILDREN (2:30 - 4:30)
Desired Extended Play Day(s)
Status of Applicant
Currently Enrolled October 11, 2022
Switching Programs or Staff Child(ren) October 14, 2022
Sibling of Currently Enrolled Child(ren) October 14, 2022
Alumni October 18, 2022
Summer Alumni & 22-23 Waitlist Children October 21, 2022
Community applicant October 24, 2022
Check here if interested in financial aid.
A Child’s Place has discussed with me their discipline and behavior management. I received a written copy of these policies. The policy is also available at https://www.a-childs-place.org/discipline.html.
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 free.
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