Application | Little Folks Daycare

Date: required

Child's Name:

Child's Date of Birth: required

Child's Sex:

Child's Place of Birth:

Social Security #:

Mother's Name:

Mother's Date of Birth:

Mother's Place of Birth:

Mother's Social Security #:

Mother's Address: *

Mother's Phone #:

Mother's Gross Monthly Income:

Mother's Hours Worked Weekly

Father's Name:

Father's Date of Birth:

Father's Place of Birth:

Father's Social Security #:

Father's Address:

Father's Phone #:

Father's Gross Monthly Income:

Father's Hours Worked Weekly

Are There Any Other Children in Your Family? If So How Many?

Type of Child Care Are You Looking For?

Income Eligible

Voucher

Private

Number of Child Care Days Needed Each Week?

3 Days Per Week

4 Days Per Week

5 Days Per Week

How Long Do You Need Child Care Each Day?

Full Time (6-10 Hours)

Part Time (5 Hours)

Are You Or Your Partner Currently Enrolled In School or a Training Program?

Enrolled In School

Enrolled In Training

Not Enrolled

If You Are Not Working Are You Currently Seeking Employment?

Looking For Employment

Not Looking For Employment

N/A Not Applicable

How Did You Find Out About Little Folks?

Application For Daycare