Alchesay Beginnings Child Development Center

Childcare Application Form
Incomplete applications will NOT be considered and will be filed away as inactive.  Contact will be made once.  No response will deem the application inactive.

Child's information

Application Date (mm/dd/yyyy)
Child's Birth Date (mm/dd/yyyy)
Child's Mailing Address
Child's Physical Address
Child's Full Name:
Returning Child?
Sex of the Child?
Special Needs?
Ethnicity of the Child?

Parents' Information

Relationship to ABC Daycare
Parent/Guardian #1 Full Name
Relationship to Child
Parent #1 Employer Please type the name of your employer into this field. If you are a student, type Student. If you are not employed, type None.
Parent #1 Work Phone Number Please include the area code in your phone number. If you don't have a work phone, type your home phone or None.
Parent #1 Cell Phone Number Please include the area code in your phone number. If you don't have a work phone, type your home phone or None.
Parent #1 Email:
Parent/Guardian #2 Full Name
Relationship to Child
Parent #2 Employer Please type the name of your employer into this field. If you are a student, type Student. If you are not employed, type None.
Parent #2 Work Phone Number Please include the area code in your phone number. If you don't have a work phone, type your home phone or None.
Parent #2 Cell Phone Number Please include the area code in your phone number. If you don't have a work phone, type your home phone or None.
Parent #2 Email:

Other Children in the Household

Child's Full Name
Child's Full Name
Child's Full Name
Child's Full Name
Child's Full Name
Sex
Sex
Sex
Sex
Sex
Birth Date (mm/dd/yyyy)
Birth Date (mm/dd/yyyy)
Birth Date (mm/dd/yyyy)
Birth Date (mm/dd/yyyy)
Birth Date (mm/dd/yyyy)
Daycare Payment Agreement By clicking on the "Yes" button below I acknowledge that I understand that child care fees are a flat bi-weekly rate of $300.00 for infant/toddlers, $280.00 for preschoolers, and $260.00 for school-aged children. Drop in care is available at $40.00 per day prepaid. I agree to pay all child care fees within 5 days of the billing cycle or my child may be dropped from ABC Daycare. Unpaid fees may result in legal action.
Daycare Payment Agreement Certification Full Name Please type in your full name below to certify your agreement to the Daycare Payment Agreement.