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Park Slope Child Care Collective Application
186 St. Johns Place, Brooklyn, NY 11217 | 718-399-0397 | www.psccc.org | admissions@psccc.org

The Park Slope Child Care Collective is a not-for-profit, licensed, full-day child-care center, founded by neighborhood parents in 1971 to provide a stimulating and nurturing environment for the young children of working parents. The Collective strives to make the student body racially, ethnically, culturally, and socioeconomically diverse. Through our classroom books, activities, play materials, and discussions, children learn to recognize what they have in common with one another, while respecting and enjoying what makes each of them special and unique. We welcome and are supportive of all families and are inclusive of children of all abilities.

Please complete the application form below (one per child) and submit the application fee (see below) by January 1, 2019 to apply for entry for the 2019-20 school year. Please note that we prioritize September 2019 entry during the winter admissions period. We refer to waitlist applications at other times in the year. Please use the last question for additional information you would like to share with us. Thank you for your interest in the Park Slope Child Care Collective.

BASIC INFORMATION
Child's First Name *
Your answer
Child's Middle Name
Your answer
Child's Last Name *
Your answer
Child's Nickname (If Any)
Your answer
Age of child as of September 1st of Entry Year *
Child's Birthdate (MM/DD/YYYY) *
Your answer
Child's Gender *
Your answer
Home Address 1 *
Your answer
City 1 *
Your answer
Zip Code 1 *
Your answer
Home 1 (or Primary) Phone Number (XXX) XXX-XXXX *
Your answer
Home 2 Address (if applicable)
Your answer
Home 2 Phone Number (if applicable) (XXX) XXX-XXXX
Your answer
Parent/Guardian1 First Name *
Your answer
Parent/Guardian1 Last Name *
Your answer
Parent/Guardian1 Email Address *
Your answer
Parent/Guardian1 Cell Phone (XXX) XXX-XXXX
Your answer
Parent/Guardian1 Work Phone (XXX) XXX-XXXX (If Applicable)
Your answer
Parent/Guardian1 Occupation (If Applicable)
Your answer
Parent/Guardian1 Company Address/City/State/Zip (If Applicable)
Your answer
Parent/Guardian2 First Name (If Applicable)
Your answer
Parent/Guardian2 Last Name (If Applicable)
Your answer
Parent/Guardian2 Email Address
Your answer
Parent/Guardian2 Cell Phone (XXX) XXX-XXXX
Your answer
Parent/Guardian2 Work Phone (XXX) XXX-XXXX (If Applicable)
Your answer
Parent/Guardian2 Occupation (If Applicable)
Your answer
Parent/Guardian2 Company Address/City/State/Zip (If Applicable)
Your answer
Please List the Names and Relationships of All the People in Your Child's Household
Family Member1 First and Last Name
Your answer
Family Member1 Relationship to Child
Your answer
Family Member2 First and Last Name
Your answer
Family Member2 Relationship to Child
Your answer
Family Member3 First and Last Name
Your answer
Family Member3 Relationship to Child
Your answer
Family Member4 First and Last Name
Your answer
Family Member4 Relationship to Child
Your answer
Please List Here Any Other Persons in Household and Their Relationship to Child
Your answer
ABOUT YOUR CHILD
Has your child ever been enrolled or is your child currently enrolled in a daycare or preschool? *
If so, when and where?
Your answer
If not, who is your child's primary caregiver?
What are your goals for your child in an early childhood program? *
Your answer
Why have you chosen to apply to the Park Slope Child Care Collective in particular? *
Your answer
Briefly describe your child's personality. Tell us what activities your child likes best. *
Your answer
What is a typical day like for your child? *
Your answer
How does your child respond to new situations? Describe any separation experiences your child has had (e.g., new school / playgroup / nanny) and how your child responded to these experiences. *
Your answer
Do you have any concerns about your child's development? Has your child been formally diagnosed with any developmental delays? PSCCC supports an environment inclusive of children of all abilities. *
Your answer
At what age did your child begin to speak? *
Your answer
Describe your child's speech and use of language. *
Your answer
What is the PRIMARY language your child speaks/is spoken to at home? *
Your answer
Does your child speak more than one language at home? *
If so, what language(s)?
Your answer
Is there any other information about your child that we should know?
Your answer
ABOUT YOUR APPLICATION AND YOU
I (we) are interested in PSCCC's program for (check one) days a week:
Preference for the (check one age group) class: *
Are you interested in the tuition assistance program? If yes, you will receive a tuition assistance application after your scheduled play visit. *
Please check which days you would like your child to attend: FIRST CHOICE SCHEDULE *
Required
Please check which days you would like your child to attend: SECOND CHOICE SCHEDULE *
Required
Application Status (check one) *
Please check how you will pay the application fee (check one). Please pay application fee the same day you submit the application. *
How did you hear about the Park Slope Child Care Collective? *
Your answer
Please share how you (through your profession or personal interests) might contribute to our cooperative school environment. *
Your answer
Is there any other information that you would like us to know? Please feel free to share about your family, background, etc.
Your answer
Completed applications are due by Tuesday, January 1, 2019.
To complete your application, please SUBMIT your responses on this form below AND pay the application fee. You can mail or drop off a $50 non-refundable fee made payable to Park Slope Child Care Collective OR make a $52 online payment at http://psccc.org/wp/apply.

If you have previously applied and are re-applying, or if you are now applying for the sibling of a previous/current applicant or previous/current Collective student, please indicate that in the last question and do not submit another application fee. The application fee is a one-time charge per family, e.g., twin applicants submit one application fee. Completed applications are due by Tuesday, January 1, 2019. Late applications will be accepted and placed on an active waitlist.

Once we receive your completed application (online application AND fee), we will contact you to arrange a play visit in December or January.

Have questions? Feel free to visit www.psccc.org for further information or contact us at admissions@psccc.org. Thank you again for your interest in the Park Slope Child Care Collective.

I, the Parent/Guardian1 Named Here, Submit This Application for My Child to PSCCC (check and initial in lieu of signature) *
Required
Initials *
Your answer
Date (MM/DD/YYYY) *
Your answer
I, the Parent/Guardian2 Named Here, Submit This Application for My Child to PSCCC (check and initial in lieu of signature)
Initials
Your answer
Date (MM/DD/YYYY)
Your answer
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