CHILD DEVELOPMENT CENTER
2710 Kingston Road, York, PA 17402
ph. 717-757-6390     (717) 755-1382
Email:_______________

Web Site Home > CDC Home > CDC Wating List Application >

FIRST CHURCH OF THE BRETHREN CHILD DEVELOPMENT CENTER
WAITING LIST APPLICATION




Click here for a printable form.
If you wish to enroll on the waiting list, print out the form, fill it out and mail it to
FIRST CHURCH OF THE BRETHREN CHILD DEVELOPMENT CENTER
2710 Kingston Road, York, PA 17402


Child_________________ Sex ______________ Date of Birth ________________________
Address ________________________________ Phone ________________________________
Phone ________________________________
Parent __________________________________ Email ________________________________
Home Address ___________________________ Phone ________________________________
Place of Employment _______________________ Phone ________________________________
Email ________________________________
Parent __________________________________ Email ________________________________
Home Address ___________________________ Phone ________________________________
Place of Employment _______________________ Phone ________________________________
Email ________________________________
□ Full Time Care Date_____________________
□ Part Time



Parent’s Signature __________________________

Parent’s Signature __________________________

Director’s Signature __________________________ 		Date ______________

Date ______________

Date ______________

The receipt of the form is in no way implies that the child will receive a space in the First Church of the Brethren’s Child Development Center. This application will place the child’s name on a waiting list.                      Revised: 2/21/07