On-line application – Friends Center for Children

Child's Name *

First

Last

Child's Date of Birth *

Tell us about your child *

Previous Child Care Provider (if any)

Home Language(s) *

Do you live in New Haven?

Does your child have any special physical, cognitive, or emotional needs?

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Employer

Work Phone/Email

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Employer

Work Phone/Email

How did you hear about Friends Center for Children and why are you interested in having your child come to the center? *

We have a sliding-scale tuition system. Please indicate your yearly income. *

Notes regarding yearly income (if applicable)

How many people are in your household? (please ONLY list parents/guardians and children under 18 including any current pregnancy) *

Notes regarding household size (if applicable)

Application Fee

Price: $ 35.00