If you would like to enroll your child/children at Duck Pond Day Care, please enter the information below and submit. Or if you prefer, you may print the application, and mail to the main office in Milford or fax the completed form to: (203) 882-8287

 

 
CHILD INFORMATION
Last Name
First Name
Middle Name
Gender: Male Female
Birth Date/Due Date
Requested Start Date
Please select the days and specify the times for each day
for requested child care*:
Monday Hours:
Tuesday Hours:
Wednesday Hours:
Thursday Hours:
Friday Hours:
*There is a 4 hour minimum per day of child care. Please note that our
Hours of Operation are 7:15am — 6:00pm.
 
FAMILY INFORMATION
Parent/Guardian
Last Name
Parent/Guardian
First Name
E-Mail Address
Street Address
 
City
State
Zip
Home Phone
Work Phone
Cell Phone
Please check this box if this is the main parent/guardian
to contact for enrollment purposes.
 
Parent/Guardian
Last Name
Parent/Guardian
First Name
E-Mail Address
Street Address
 
City
State
Zip
Home Phone
Work Phone
Cell Phone
Please check this box if this is the main parent/guardian
to contact for enrollment purposes.
 
ADDITIONAL INFORMATION
Best time and phone number to reach you:
 
How did you hear about our center?
 
Has your child been in a daycare setting before? Yes No
If Yes, was it a positive experience? Yes No
Please specify reason for leaving:
 
Please note: This application does not guarantee your child's enrollment. Deposits are not refundable before enrollment.

 

 
       
   
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