Program Application Infant-PS/PreK

Karen Marino, Director of Infant – PS/PreK Enrollment

kmarino@countrychildrenscenter.org

914-242-0520 ext 501

A SEPARATE APPLICATION NEEDS TO BE COMPLETED FOR EACH CHILD
A $20 filing fee per application is required to place your child(children) on our waiting list.
You will be prompted to either mail in a check or pay electronically after you hit the Submit button.
A correspondence will be sent to you upon receipt of your application and filing fee.

Child's First and Last Name *

Date of Birth or Expected DOB *

Street Address *

City

State/Province

ZIP / Postal Code

Parent/Guardian #1 First and Last Name *

Email Address *

Home Phone *

Cell Phone *

Employer

If employed by IBM, which site?

Parent/Guardian #2 First and Last Name

Email Address

Home Phone

Cell Phone

Employer

If employed by IBM, which site?

Desired Building (1st Choice) *FarmBedford HillsWhite HouseWatsonKitchawan BarnsOak Ridge

Desired Building (2nd Choice) *FarmBedford HillsWhite HouseWatsonKitchawan BarnsOak Ridge

Desired Start Date *

Desired Day(s) *

NoneMonTueWedThuFri

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