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 Name
Last Name
Birth Date or Due Date
-
Month
-
Day
Year
Date
Gender
Female
Male
Unknown
Do you have another child you need to add to the applicant pool?
no
yes
Child's Name (enter "Baby" if undecided)
First Name
Last Name
Birth Date or Due Date
-
Month
-
Day
Year
Date
Gender
Female
Male
Unknown
Parent 1 Name
First Name
Last Name
Parent 1 Email
example@example.com
Parent 1 Phone Number
-
Area Code
Phone Number
Parent 1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 1 Employer
Parent 1 Occupation
Parent 1 Work Phone Number
-
Area Code
Phone Number
Parent 2 Name
First Name
Last Name
Parent 2 Email
example@example.com
Parent 2 Phone Number
-
Area Code
Phone Number
Parent 2 Address (If Different from Parent 1)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2 Employer
Parent 2 Occupation
Parent 2 Work Phone Number
-
Area Code
Phone Number
What is your ideal timing for joining Child's Day?
ASAP
Spring 2025
Summer 2025
Fall 2025 (August)
Winter 2026
Spring 2026
Summer 2026
Fall 2026 (August)
Winter 2027
Other, please specify
If other, please specify
If we don't have an opening for your ideal timing, when else would you consider joining Child's Day?
ASAP
Whenever space is available
Winter 2025
Spring 2025
Summer 2025
Fall 2025 (August)
Winter 2026
Spring 2026
Summer 2026
Fall 2026 (August)
Other, please specify
If other, please specify
I heard about the center from
Friend
Coworker
Google
Yelp
Nextdoor
Facebook
Sibling Attends/ed Child's Day
Other, please specify
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
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Application Fee
$
75.00
Enter coupon
Apply
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.
Name of Person Completing Form
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Are you still interested in enrollment at Child's Day?
Please Select
Yes, please keep my child(ren) on the wait list.
No, please remove my child(ren) from the wait list.
I'm not sure, please contact me.
Submit
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