26/27 ACP FIVES Application

2026-2027

A Child's Place Fives Application

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 and Due Date*

Currently Enrolled -- October 17, 2025Sibling of Currently Enrolled -- October 20, 2025Children's Community Development Center Families -- October 22, 2025Community applicant -- October 24, 2025
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact/Guardian Information

First Person to Contact
Primary Contact/Guardian Name

First NameLast Name
Primary Contact/Guardian Phone
Primary Contact/Guardian Phone Type
Primary Contact/Guardian Email
example@example.com
Primary Contact/Guardian Relationship to Child
Secondary Contact/Guardian Information

If First Contact cannot be reached
Secondary Contact/Guardian Name

First NameLast Name
Secondary Contact/Guardian Phone
Secondary Contact/Guardian Phone Type
Secondary Contact/Guardian Email
example@example.com
Secondary Contact/Guardian Relationship to Child
Fives Program - 5 years by 12/31/26*

FIVE PART DAYS (8:30 - 2:30) $18,250 per year **FIVE EXTENDED DAYS (8:30 - 4:30) $22,000 per year **FIVE FULL DAYS (7:30 - 6:00) $24,000 per year **EXTENDED PLAY FOR PART DAY CHILDREN (2:30 - 4:30) $700.00 per day/per year**
** Based on 25/26 Tuition Rates subject to change yearly
Desired Extended Play Day(s):

MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY
A NON-REFUNDABLE FEE OF $50 MUST BE RECEIVED FOR THIS APPLICATION TO BE PROCESSED (ACCEPTED AND WAITLISTED)

Payment can be made by check to A Child's Place, or online at https://securepayment.link/achildsplace/
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Primary Contact/Guardian Information

Secondary Contact/Guardian Information

** Based on 25/26 Tuition Rates subject to change yearly