Ruth Staples Child Development Lab - Application Form

Submit this Application to the Child Development Laboratory School. There is a $15.00 non-refundable application fee.

The enrollment process is ongoing year round and openings are filled as they become available in the program. We take into account the application date it was received, we strive for an inclusive classroom taking into account creating an environment that values children from diverse backgrounds, ethnicities, race, and gender identity. Upon the Enrollment Offer, a $50.00 non-refundable Enrollment Fee is due with the return of your packet paperwork, which will include verification of required immunizations before attendance will be allowed. Refer to our webpage for additional information about our program including our rates and yearly calendar.

About the Child

*Child's Name: ( Last, First M.I. )
*Child's Gender Identity:
*Child's Birth Date: ( Note: Actual Birthdate Required )
Month: Day: Year:

About the Parents/Guardians

*First Guardian's Name ( Last, First )
*First Guardians Day Phone
*Relation:

Second Guardian's Name: ( Last, First )
Second Guardian's Phone:
Relation:

Home and Contact Information

*Home Address:
*City:
*State:
*Zip:
*Phone:
*E-mail:
*Languages spoken in the home:
*Race:
*Notes or additional information:

*Required Fields