Enroll Now! - Kidstop Developmental Child Care Center

Please print out this page, fill it in and mail it to: Kidstop, 215 Bridgeport Avenue, Shelton, Ct., 06484. A non-refundable fee of $55.00 must accompany this application for full or permanent part time applicants. An annual fee of $25.00 dollars for Flex applicants. Please pay with check or money order.

Date

Child's Name

Sex

Address

Age

Date of Birth

Mother or Guardian
Name
Home Address
Home Phone
Employer
Address
Work Phone

Father or Guardian
Name
Home Address
Home Phone
Employer
Address
Work Phone

If you will be paying Kidstop with a personal check, also complete the following for each person who will be making checks to us during your child's tenure.

Date of Birth
CT. Driver's License

Date of Birth
CT. Driver's License

Desired Starting Date

Schedule: Days

Hours