27/28 A Child's Place - First Steps Application Current Student

2027-2028

A Child's Place First Steps Current 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
2 digit month, 2 digit day, 4 digit yearDate
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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 Relationship to Child
Primary Contact/Guardian Phone
Format: (000) 000-0000.
Primary Contact/Guardian Email
example@example.com
Secondary Contact/Guardian Information
Secondary Contact/Guardian Name

First NameLast Name
Secondary Contact/Guardian Relationship to Child
Secondary Contact/Guardian Phone
Format: (000) 000-0000.
Secondary Contact/Guardian Email
example@example.com
Status of Applicant
12 Month First Steps Program Interested in:
What is your first choice for days?
What is your second choice for days?
A Child's Place has informed me of their discipline and behavior policies.
https://www.a-childs-place.org/discipline.html
Check if interested in Financial Aid
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: