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Enrollment Registration
Complete this form to begin the enrollment process for Fairfield Child Development Center.
Child Information
Session Option
*
Select a session
Child's Full Name
*
Name to be used in class
Birthday
*
Age (before Oct 1)
Gender
Select gender
Home Address
Street Address
*
City
*
Zip
*
Home Phone
Mother's Information
Mother's Name
Cell Phone
Email
Employer/Career Training
Work Phone
Father's Information
Father's Name
Cell Phone
Email
Employer/Career Training
Work Phone
Family Information
Marital Status
Select marital status
Primary language spoken in the home
Child lives with
Both parents
Mother
Father
Grandparents
Other
List names and ages of siblings
Preschool History
Has your child attended preschool before?
Select
FCDC Returning Student
Select
How did you find out about FCDC?
Additional Information
Please add any additional information about your child that you consider helpful (physical, social, emotional, academic, speech or medical issues)
Submit Registration
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