Registration | Child Development Center | Chicago State University-188bet金宝搏官网登录网址

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Recruitment Form for David Kanis Child Development Center. Please fill out this form and we will get in touch with you shortly.

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Child

*Which program are you applying for:

Center-base (3-5 years old)After School Program (6-12 years old)

*First Name:

*Last Name:

*Birth Date

*Primary Language

Parent/Guardian

*First Name

*Last Name

*Address

*City

*State

*Zipcode

*Phone

*Email Address:

*Relationship to Applicant