Child: _____________________________ Birth/Due Date: ___________
Father/Guardian Name : ___________________________Avon Employee: Y/ N
Mother/Guardian Name: ___________________________Avon Employee: Y/ N
Home Address: _______________________________________________
___________________________________________________________
Father Work phone_________________ Mother Work phone__________________
Home ___________________E-Mail 7am-6pm_____________________@_____
Approximate Drop-off/Pick-up Times: _________________________________
Desired Starting Date: _____________________________
I am interested in enrolling my child in: ________ Full Time _______ Part Time
For PT, please indicate desired days
2 Days: M T W TH F _____can be flexible
3 Days: M T W TH F _____can be flexible
* There is a $75.00 non-refundable application fee per child. This fee ensures that your child is placed on our wait list and does not guarantee future enrollment.
** Please include a check made payable to Little Angels Child Care Center and enclose it with this application. Mail to: Midland and Peck Avenues Rye, NY 10580
Office Use Only
Date Received: Check # : Date 18 months: Date 3 years:
Dates of Contact: