Green Room

Child’s Information

First Name

Middle Initial

Last Name

Please check the session that you are enrolling your child for:

Fall Session

Spring Session

Female
Male

Age

* Your child must be 15 months old by the first day of the semester.

Date of Birth

Parent/Guardian Information

First Name

Middle Initial

Last Name

Relationship to Child

Please select what applies to you:

MCC Student

MCC Employee

Community Member

Student ID#

Street Address

City

State

Zip

Phone number of where to reach you

Employment Information

Employer Name

Employer Address

City

State

Zip

Employer Phone

Work Schedule (Days and Times)

Not Currently Employed

Are you on financial aid?

Yes

If yes, what kind?

Pell Grant

Other

If other, please describe

Do you plan to use financial assistance from Illinois Child Care Assistance Program (CCAP)?

Yes

Requested Schedule

Please indicate below the days/times you would like to enroll your child in the Children's Learning Center. All schedules begin ten minutes before the hour.
For example, if you are in a class from 1-2:20 p.m., you would contract from 12:50-2:50 p.m.

Monday

Tuesday

Wednesday

Thursday

A non-refundable Registration Fee for the Green Room is $25 per semester (Fall and Spring). Fees must be paid before your child’s first day in the Green Room. All fees and payments are to be paid in Registration (A-258), either in person or over the phone by calling (815) 455-8588. Payments cannot be made through the Lillio app.