Request for Child Care Form

Name of Person Requesting Care

Phone (Home)

Phone (Work)

Email Address

Child's Full Name

Date of Birth or due date

Classroom

Infant (6 weeks - 18 months) Toddler (12 months - 36 months) Preschool (2.5 years - 3.5 years) Preschool (3.5 years - 5 years)

Affiliation with the College

Category A-Children of full-time College employees with benefits and full-time students. Only full time employee’s and students’ families may qualify for the tuition discount program. Category B-Children of families associated with the College, i.e., retirees, block visitors, part-time employees, alumni, part-time students, food service full-time employees, and grandchildren of Category A employees. Category C-Children of parents not affiliated with the College.

Offices & Services

Cheryl Schlessman Bennett Children's Center