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Children's Learning Center Application
Red Room
Child's Full Name
First Name
Middle Initial
Last Name
I would like for my child to be enrolled in preschool:
Please check the session that you are enrolling your child for:
Fall Session
Spring Session
Gender
Female
Male
Age
--Select--
2½-3 years
3-4 Years
4-5 Years
5+ Years
Date of Birth
Name of Person Filling Out Form
First Name
Middle Initial
Last Name
Relationship to Child
--Select--
Parent
Legal Guardian
Other
Are you on financial aid?
Yes
No
If yes, what kind?
Pell Grant
Financial Aid
Other
If other, please describe
Please select what applies to you:
MCC Student
MCC Employee
Community Member
Student ID#
Street Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Email
Phone number of where to reach you
May we send texts to this number?
Yes
No
Best day and time to reach you
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
None
7:50 AM
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
to
Monday End
None
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
4:50 PM
Tuesday
None
7:50 AM
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
to
Tuesday End
None
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
4:50 PM
Wednesday
None
7:50 AM
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
to
Wednesday End
None
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
4:50 PM
Thursday
None
7:50 AM
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
to
Thursday End
None
8:50 AM
9:50 AM
10:50 AM
11:50 AM
12:50 PM
1:50 PM
2:50 PM
3:50 PM
4:50 PM
A non-refundable enrollment fee for the Red Room is $25 for the Fall and $30 for the Spring semesters. The additional $5 fee covers mandatory vision/hearing screening. Fees are required before your child’s services begin. All fees and payments are to be paid in Registration (A-258), either in person or over the phone ((815) 455-8588). The Children's Learning Center Application can not accept payments.
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