YWCA of Minneapolis

minneapolis

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Child Care Business Development Program

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Application Form

Please complete and submit the form below.

You may also download, print and mail or fax the application (PDF file) to:

YWCA Downtown

Attn: Children's Center

1130 Nicollet Mall

Minneapolis, MN 55403

Fax: 612-332-0500

Please fill in the following information and click the Send Form button.

Child(ren)'s Information

	Full Name	Date of Birth	Gender
Child 1			Male Female
Child 2			Male Female
Child 3			Male Female

Parent/Guardian's Information

Name

Address

City

State

Zip

Day Phone

Evening Phone

Care Information

1. Please select the type(s) of care you need. We offer full time care only, Monday through Friday.
Check all that apply.

	Infant Child Care (6 weeks to 16 months)
	Toddler Child Care (16 to 33 months)
	Preschool Child Care (33 months to kindergarten)
	School Age Care (Kindergarten to Grade 3)

2. Please indicate your location preference.

	YWCA Downtown Children's Center
	YWCA Phillips Strong Beginnings
	YWCA Midtown Strong Beginnings
	YWCA Abbott Northwestern Hospital

3. How did you hear about the YWCA Children's Center?

	Website
	Brochure
	Friend

	Parent in the Program
	Staff
	Other

If Other, please explain:

4. I would like to begin:

	On this date:
	First Available Opening

5. Is there a brother or sister already in our center or on the waiting list?
If so, please fill in the following information.

Sibling's Name and Age:
Are you willing to start one child at a time? Yes No

6. How will your tuition be paid?

	No financial assistance needed
	County Subsidy
	Program Name
	Contact's Name
	Phone
	Other Funding Subsidy
	Program
	Phone

No money is due until your child is accepted. Upon acceptance there is a $60.00 registration fee. An immunization record is required when the child begins the program.