Children's Learning Center Application

Green Room

Child's Full Name




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


Gender

Name of Person Filling Out Form




Are you on financial aid?


If yes, what kind?



Please select what applies to 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.
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A non-refundable enrollment fee for the Green 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.