Published using Google Docs
MCM_Application
Updated automatically every 5 minutes

 MidCoast Munchkins

1001 Old Stage Rd.

Woolwhich, ME 04579

207.613.5439

Application

Name of Child(ren): ___________________________________________________

Date of Birth: ________________________________________________________

Today’s Date: __________________

Start Date: _____________________   End Date: _________________

Parent/Legal Gaurdian Name: ____________________________________________

Phone Number:______________________  Email: ___________________________

Address: _____________________________________________________________

Employment: _________________________________________________________

Parent Name/Legal Gaurdian: ____________________________________________

Phone Number:______________________  Email: ___________________________

Address: _____________________________________________________________

Employment: _________________________________________________________

Number of people in your household:

Has all in the house received the COVID Vaccine who are eligible?

Days Needed:    

      Tues   Wed     Thur        Fri          

Hours Needed (Hours Available 7:30am-5pm): ______________________________

How did you hear about us? _____________________________________________

Has your child ever been in childcare before?        Yes       No

If yes, where? _________________________________________________________

Reason for leaving? ____________________________________________________ ____________________________________________________________________________________________________________________________________________