25/26 A Child's Place - First Steps Application New Student

25/26 A Child's Place - First Steps Application New Student

2025-2026

A Child's Place First Steps New Student Application

7:15 AM - 6:00 PM

FULL/PART WEEK (2-day minimum)

APPLICATIONS DO NOT ROLL OVER - YOU MUST REAPPLY EACH NEW SCHOOL YEAR
Child's Name:

First NameLast Name
Date of Birth

MonthDayYear
Date
Date

MonthDayYear
Date
Status of Applicant
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact/Guardian Information

First Point of Contact
Primary Contact/Guardian Name

First NameLast Name
Primary Contact/Guardian Phone
Format: (000) 000-0000.
Primary Contact/Guardian Phone Type
Primary Contact/Guardian Email
example@example.com
Secondary Contact/Guardian Information
Secondary Contact/Guardian Name

First NameLast Name
Secondary Contact/Guardian Phone
Format: (000) 000-0000.
Secondary Contact/Guardian Phone Type
Secondary Contact/Guardian Email
example@example.com
12 Month First Steps Program Interested in:
What is your first choice for days?
What is your second choice for days?
Check if interested in Financial Aid
Desired Start Date (if different than 8/25/25)

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
Should be Empty: