Childcare Application

Children are registered on a first come, first served basis. Your application is not complete until we receive your $25 registration fee.

The following information will be e-mailed to a CLC employee. Please remember that email is not a secure medium. Do not sent personal or sensitive information.

Application Information
  1. 15 months to 3 years (Green Room) 3 to 5 years (Red Room)
  2. Fall Spring Intersession Summer
Child’s Information
  1. male female
  2. (mm/dd/yy)
Applicant’s Information
  1. MCC studentMCC employee
  2. Yes No
  3. I am taking the following classes:
  4. Please check the days you need your child enrolled in the Children's Learning Center and enter the hours you need. Scheduling is done ten minutes to the hour. For example, if you are in class from 1 to 2:20 p.m., you would contract from 12:50 to 2:50 p.m.
  5. Time
  6. Time
  7. Time
  8. Time
  9. Time
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