Virginia Marx Children's Center Application Form for Enrollment

Virginia Marx Children’s Center Application Form for Enrollment

About Your Child

Child\'s Name *

Date of Birth *

Home Address *

Apt, suite, etc.

Country

City

State

Zip code

About You

Parent\'s Name *

Home Address *

Apt, suite, etc.

Country

City

State

Zip code

Phone (Home) *

Email *

Occupation *

Employer\'s Name *

Employer\'s Address *

Apt, suite, etc.

Country

City

State

Zip code

Phone (Work) *

Phone (Cell) *

Parent\'s Name (2) *

Home Address *

Apt, suite, etc.

Country

City

State

Zip code

Phone (Home) *

Email *

Occupation *

Employer\'s Name *

Employer\'s Address *

Apt, suite, etc.

Country

City

State

Zip code

Phone (Work) *

Phone (Cell) *

Are You

Westchester Community College *

Full-Time Student

Part-Time Student

Staff

Faculty

If you are staff or faculty, please provide us with your department and your extension *

If you are a student, please provide your Student ID *

Hours Requested *

Full-Time

Part-Time (Student parent - minimum of 20 hours required per week)

Or A

Community Parent *

Community Parent Full-Time

Community Parent Part-Time

Note

A non-refundable registration fee is charged for the enrollment of each child:
$75.00 for children of WCC staff, WCC faculty, County Employees & Community Parents
$30.00 for children of WCC student-parents

Westchester Community College, State University of New York

Virginia Marx Children’s Center Application Form for Enrollment

Student Services