Community Enrollment Application 

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. Child First and Last Name:

* 2. Child Information:

* 3. Primary Parent Information 

* 4. Secondary Parent Information (if applicable)

* 5. We are open 6:30am to 5:30pm and closed on Holidays. All children need to be dropped off by 9:30 to start their day. What hours of care do you need?

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

* 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:

* 10. My child is in the process for/or currently has: (select all that apply)

* 11. Select any that apply:

* 12. Please share any information you would like us to know.

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