Child Enrollment Form

First Name

Last Name

Email *

Phone *

Form completed by:

Mother

Father

Legal Guardian

Other

Child's Full Name

Child's Age:

Child's Date of birth

Enrollment Date

Start Date

Enrollment type

Daycare

Summer Program

After School Program

Sports Program

I confirm that am interested in enrolling my child(ren) at Clever Cubs Daycare in New York City. This information will be used by the Daycare and possibly the Department of Education to determine eligibility and/or acceptance.

Application Fee *

$ 300

Other amount