Admissions Application

Admissions Application

Thank you for your interest in Child's Day. Please complete this form to be added to our applicant pool. There is a $75 per family fee to be placed in the applicant pool.
Child's Name (enter "Baby" if undecided)

First NameLast Name
Birth Date or Due Date

MonthDayYear
Date
Gender
Do you have another child you need to add to the applicant pool?
Child's Name (enter "Baby" if undecided)

First NameLast Name
Birth Date or Due Date

MonthDayYear
Date
Gender
Parent 1 Name

First NameLast Name
Parent 1 Email
example@example.com
Parent 1 Phone Number

Area CodePhone Number
Parent 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 Employer
Parent 1 Occupation
Parent 1 Work Phone Number

Area CodePhone Number
Parent 2 Name

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Phone Number

Area CodePhone Number
Parent 2 Address (If Different from Parent 1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2 Employer
Parent 2 Occupation
Parent 2 Work Phone Number

Area CodePhone Number
Our/My preference is to start:
If other, please specify
We/I would consider starting:
If other, please specify
I heard about the center from
If other, please specify
Do you know any current Child's Day families? If yes, please list their name below.
Is there anything else you'd like to share with us about your family or your child?

My Products

Application Fee$75.00

Enter coupon

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Signature - I understand submitting an application and fee does not guarantee enrollment.

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Name of Person Completing Form

First NameLast Name
Today's Date

MonthDayYear
Date
Are you still interested in enrollment at Child's Day?
Should be Empty: