Apply

Download or fill out the form below:

Child's name:

Child’s Address:

Date of Birth:

Sex:

Phone Number:

Enrolling Parent/Guardian Name:

Name of Parent(s)/Guardian(s):

Child Primarily Resides With:

Parents Are:

Parents Are

Is there a parenting plan in place?:

If yes, a copy must be provided to WCDCI before the child’s first day of attendance.

My child’s weekly care schedule will be:

Mother’s Employer:

Mother’s Email Address:

Business Phone:

Father’s Employer:

Father’s Email Address:

Business Phone:

A deposit of $50.00 must accompany this application. I further understand that this form, when signed by me, is a valid contract between WCDCI and myself. Fees are payable as explained in the Financial Obligation Form.

Parent(s) Signature:

Downloadable Documents:

Address: 317 Elk Street Gassaway, WV 26624

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