LINDENHURST UFSD
CHILDCARE APPLICATION - SCHOOL YEAR 2020-21
Email address *
Student's Last Name: *
Student's First Name *
Contact Phone # *
Student's School of Attendance as of Sept 2020 *
Student's Grade as of September 2020 *
Has there been a change in home address since last school year? *
Home Address *
Type of Childcare: *
Please select Licensed Daycare
Private Childcare Name *
Private Childcare Address
Private Childcare Phone #
Check Days of Week Student will Attend Daycare *
Required
Please select one: *
Comments:
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