*
Required
Child Information
Desired Start Date
*
required
(mm/dd/yyyy)
Child's First Name
*
required
Child's Last Name
*
required
Child's Preferred Name
*
required
Date of Birth
*
required
(mm/dd/yyyy)
Place of Birth
*
required
Gender*
Female
Male
Street Address
*
required
State
*
required
City
*
required
Zip Code
*
required
Home Phone
*
required
Family Information
Parent 1 First Name
*
required
Parent 1 Last Name
*
required
Is Parent 1 Address Same as Child?*
Yes
No
Parent 1 Street Address
*
required
Parent 1 City
*
required
Parent 1 State
*
required
Parent 1 Zip Code
*
required
Parent 1 Home Phone
*
required
Parent 1 Cell Phone
*
required
Parent 1 Email
*
required
Parent 2 First Name
Parent 2 Last Name
Is Parent 2 Address Same as Child's
Yes
No
Parent 2 Street Address
Parent 2 City
Parent 2 State
Parent 2 Zip Code
Parent 2 Home Phone
Parent 2 Cell Phone
Parent 2 Email
Other Children in the Family
Name
Age
School
Name
Age
School
Name
Age
School
Priority Applicant Relationship
Please check all that apply:
I am an employee of National Prebsyterian School or Church
I/We have a child currently enrolled at National Presbyterian School and/or National Presbyterian Child Care Center
I/We are members of National Presbyterian Church
Schedule Preference
Please check one: *
I/We are interested in full-time care only (Monday-Friday, All Day)
I/We are interested in full-time care (Monday-Friday, All Day) but would accept part-time care (e.g. Mornings Only, Tuesdays & Thursdays only, etc.)
I/We are interested in part-time care only (e.g. Mornings Only, Tuesdays & Thursdays only, etc.)
Part-Time Schedule Preference
*
required
Application Fee
A non-refundable application fee of $75 must accompany this application. Applications are accepted at any time. Children are enrolled on a continuous basis throughout the year as spaces become available.*
Yes, I agree to pay the application fee.
Please send a confirmation email to the address below*: