Community Enrollment Application 2017-2018

Please complete the below application to get placed on the wait-list for Hayes Child Development Center.

Please note, you will need to submit the following documents:
*Child's Immunizations
*Most Recent Well Child Exam
*Parent/Guardian Photo ID
*Most Recent Dental Exam (1 yr +)

Please submit them either in person or via email to angela.johnson@cptc.edu and CC rachael.butler@cptc.edu

* 1. Primary Parent Information 

* 2. Secondary Parent Information (if applicable)

* 3. What are the hours of care needed?

* 4. Monthly child care costs will be paid by:

* 5. CHILD #1 INFORMATION: First, Last Name

* 6. Child # 1 : Gender; Date of Birth (in text box)

* 7. Is your child currently in care? If 'Yes' with who? (Select all that apply)

* 8. What is the child's home language?

* 9. Please select all that apply to child #1:

* 10. Child #1 is in the process for/or currently has: (select all that apply)

* 11. Please share other essential information about your child:

* 12. Select any that apply to child #1

* 13. CHILD #2 INFORMATION: First, Last Name

* 14. Child # 2 : Gender; Date of Birth (in text box)

* 15. Is your child currently in care? If 'Yes' with who? (Select all that apply)

* 16. What is the child's home language?

* 17. Please select all that apply to child #2:

* 18. Child #2 is in the process for/or currently has: (select all that apply)

* 19. Please share other essential information about child #2

* 20. Select any that apply to child #2

* 21. Please list any questions or concerns you have about our center here:

T