Application for Admission

Application for Admission

Zearing Child Enrichment Center - 633 Masonic Drive, Princeton, Illinois
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current Age*
Male/Female*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
Start Date*

MonthDayYear
Date
Zearing Child Enrichment Center is a full-time child care center. You will be charged Monday-Friday rates whether your child attends or not.
I will bring my child to the center at:*
I will pick my child up at: *
Does your child have an "active" Individualized Education Plan (IEP)?*

YesNo
We would like to apply for a subsidized slot (Per state: for families who qualify by income and family size)*

YesNo, we do not qualify
Parent/Guardian's Name*

First NameLast Name
Relationship to child:*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Employer*
Parent/Guardian's Name*

First NameLast Name
Relationship to child:*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*
Employer*
Cell Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Other Children in Family*
Additional Notes or Comments*
How did you hear about us?*

FriendFamily MemberRadioNewspaperSocial MediaOther
Please complete this form and return it to the center. If there is no immediate opening, your child's name will be placed on the “waiting List”. We will notify you as soon as an opening occurs. At enrollment time, there will be a $50.00 non-refundable application fee and an annual $30.00 activity fee due. (Activity Fee non-refundable after 30/days from enrollment date).

No family will be discriminated against because of race, sex, religion or national origin. All information listed above is confidential.
E-Signature (Type Name)*
Should be Empty: