Public School Employees’ Child Development Program Application for Enrollment Form
Email address *
How did you hear about us? If you were referred by someone, please write their name.
Your answer
Child's Name *
Your answer
Date of birth *
Age *
Your answer
Gender *
Program Placement requested (if you are flexible as to site, please rank by preference)
Atholton Multi-age Program
Cedar Lane Multi-age Program
Reservoir Infant and Toddler Program **
Long Reach Multi-age Program
Marriotts Ridge Multi-age Program
Oakland Mills Multi-age Program
River Hill Multi-age Program
Age range *
Please select type of care your child would need: *
*We do not offer a half-day program. Part-time care is 2 or 3 days per week, usually Tuesday/Thursday or Monday/Wednesday/Friday. Please indicate days that your child would need care. If you are flexible with days, please indicate. Part time care is not available at Cedar Lane Infant and Toddler.
Parent name(s): *
Your answer
Home address: (please include city and zip code): *
Your answer
Home Phone: *
Your answer
Work Phone: *
Your answer
I am employed by Howard County Public Schools *
If yes, at what school/location do you work?
Your answer
I will mail in my child’s $50.00 non-refundable application fee (checks made payable to: CDP). I understand the date and time that this response form is received at the Child Development Program office will determine my placement on the CDP wait list.
Mail applications to: PSECDP, PO Box 538, Fulton, MD 20759
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