Program Application School Age

Tiffany Baffi, Director of School Age Enrollment

tbaffi@countrychildrenscenter.org

914-242-0520 ext 309

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 Care *Before SchoolAfter SchoolBoth

Check Desired School *BHESBVESPRESWPESIMESKESMPESJJMSYorktown School District

Desired Start Date *

Child's Grade as of Desired Start Date *

Desired Day(s) for Before School *

NoneMonTueWedThuFri

Desired Day(s) for After School *

NoneMonTueWedThuFri