Join the Waitlist

Parent Registration Payment & Form

Thank you for your interest in Blakemore Children’s Center. We are committed to providing the highest quality early childhood education and care for your child. We appreciate your confidence in our program.

To join our waitlist...

Please pay our non-refundable Application Fee of $125
Then, fill out our form below

When you become eligible for enrollment, you will be contacted by phone or email and informed about the registration process.

Application Fee - $125

Registration Form

What date would you like enrollment to begin?

Who referred you to us?

First Child's Name

Current Center

Date of Birth

Second Child's Name

Current Center

Date of Birth

Parent/Guardian Information

Primary Contact

Name

Relationship

Address

Zip Code

Home Phone

Cell Phone

Email Address

Place of Employment

Work Phone

Secondary Contact (optional)

Name

Relationship

Address

Zip Code

Home Phone

Cell Phone

Email Address

Place of Employment

Work Phone

Comments

While unable to guarantee start dates, we will do everything possible to meet your needs. Enrollment is based on availability and is subject to BCC enrollment guidelines.

Parent/Guardian Signature

Date

I have paid my $125 deposit

Submittee Information

First Name

Last Name

Registration Form

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