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

2025-2026

A Child's Place First Steps Current Student Application

7:15 AM - 6:00 PM

FULL/PART WEEK (2-day minimum)
Child's Name:*

First NameLast Name
Date of Birth

MonthDayYear
Date
Date*

MonthDayYear
Date
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
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
Secondary Contact/Guardian Phone Type
Secondary Contact/Guardian Email
example@example.com
Status of Applicant

Currently enrolled - Due October 30, 2024
12 Month First Steps Program Interested in:

Toddlers (Born 9/1/2023 - 8/31/2024)Older Toddlers (Born 9/1/2022 - 8/31/2023)Preschool (Born 9/1/2020 - 8/31/2022)
What is your first choice for days?

MonTuesWedThurFri
What is your second choice for days?

MonTuesWedThurFri
Check if interested in Financial Aid

Yes
Desired Start Date (if different than 8/25/25)

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Primary Contact/Guardian Information