* 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

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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

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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

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Other Children in the Family

Name

Age

School

Name

Age

School

Name

Age

School

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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 

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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

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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*: