CENTER LOCATION

Please select which Center(s) you are applying for There is a $100 waitlist fee* for one Center and $225 for up to three Centers *TCH HUD is $50 Payment can me made via Brightwheel or by check

FCC TeleTots

HHS/ED Children's Center

The Children's House-HUD

FTC Child Care Center

Commerce Kids

Parent Name *

First Name

Last Name

Phone

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Parent Name

First Name

Last Name

Phone

(###)

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Child's Name *

Please enter "Baby" if no First Name yet

First Name

Last Name

DOB or Due Date *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired Start Date *

MM

DD

YYYY