Application for enrollment
Today's Date:_____________



-About your child-

Your child's name:
Date of birth:


Siblings (name, date of birth):




Current child care arrangements:



Projected enrollment date:


-About you-


Parent or guardian name:


Address:


Phone:

E-mail:


Place of employment:


Work address:




Work phone:




Parent or guardian name:


Address (if different from above):


Phone:

E-mail:

Place of employment:


Work address:


Work phone:



Please enclose a $30, non-refundable application fee. Checks should
be made payable to EC3, Inc. Send completed application and check to:
educational child care center
1715 main Street, lansing, mi 48915