Les Enfants Child Care

Early Childhood Center:
1275 15th Street
(at the Carriage House)
Fort Lee, NJ 07024
(201) 224-4052
Fax: (201) 224-9852

Preschool &
Summer Camp:
223 14th Street
(Corner Brinkerhoff
& 14th St.)
Palisades Park, NJ 07650
(201) 592-6695
Fax: (201) 302-9729

Preschool & Summer Camp , Palisades Park

Application

Child's Full Name:
Parent's Name:

Child's Date of Birth:
Home Telephone:		(Dashes may be used)
Parent's Work Telephone:		Ext:

Address Line 1:
Address Line 2:
Town/City:

(Please note that class placement is based on the child's age as of October 2008)
Class:	Pre K-3: 3 and 4 Years Old Pre K-4: 4 and 5 Years Old

Program Please indicate your program choice in the drop-down menu below, enter your start and end times, and the date you would like to start.
Program:			Start Time:	End Time:


Start Date Requested:
Month: ..Day: . Year:

Days Please indicate your first and second choices for programs in the drop-down menus below.
First Choice:

If "Other", please select all that apply: Monday Tuesday Wednesday Thursday Friday

Second Choice:

If "Other", please select all that apply: Monday Tuesday Wednesday Thursday Friday

Do you have additional comments, questions or special needs?