Center for
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New Child Application
PARENT'S NAME
EMAIL
PHONE
ADDRESS
CHILD'S NAME
CHILD'S BIRTHDAY
PREFERRED START DATE
SCHOOL AGE OPTION *
Choose an option
Summer Program 2021
Distance Learning Academy ONLY (7am to 2:30pm)
After-School Care ONLY (2:30pm to 6:00pm)
Full Day School Program (7am to 6pm)
Does Not Apply (Child not School-Aged)
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Submit
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DAYS OF CARE NEEDED*
Choose an option
5 days (full week)
4 days
3 days
Other (Please be advised that we require a 3 day minimum while our cohort sizes still remain small
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