Little Prince & Princess's Child Care

Little Prince & Princess's Chilcare Center

Complete the form below to allow us to best meet your needs.
Parent Name

First NameLast Name
Phone Number:

Area CodePhone Number
E-mail
Child's Name

First NameLast Name
Child's Birth Date:

MonthDayYear
Please tell us a little about your child. (example: goals, routines, etc.)
Has your child been diagnosed with any learning disability or IEP?

YesNo
If yes, please explain.
When are you seeking to enroll?

MonthDayYear
Date
Does your family receive CDC (Child care payments from the state)?

YesNo
Has your child ever attended childcare?

YesNo
If yes, when did your child last attend a childcare facility?
If your child attended child care within the past 3-6 please explain why family disenrolled from the program.
Are you seeking full time, or part time? Please include desired pick up and drop off time.
Where did you hear about us?

A Friend or colleaugeGoogleFacebookInstagramOther
Please note
1. This form does not guarantee your family enrollment. THis form is intended to gather basic information from families to see classroom placement availability.
2. There are enrollment forms that MUST be filled out in person with a $100 registration fee per child, if family is contacted for enrollment.
Privacy Policy

This information is confidential and will not be shared. This information is only intended to properly place children in available classrooms.
I have read, understood, and accepted the PRIVACY POLICY and that all information submitted is true.
Signature

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Once you submit your application, we will contact you with further questions and availabilty.

Thank you!
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Little Prince & Princess's Chilcare Center

Privacy Policy