Colfax-Mingo Childcare Enrollment & Deposit Form

Colfax-Mingo Childcare Enrollment & Deposit Form

Colfax-Mingo Childcare Enrollment & Deposit Form

Use this form to reserve a spot for your child at the Colfax-Mingo Childcare Center. A non-refundable enrollment deposit is required to hold your space. Deposits are not applied toward tuition. Spots are limited and filled on a first-come, first-served basis.
Current Young Hearts clients

DO NOT COMPLETE THIS FORM.

Age Group	5 Days	4 Days	3 Days	2 Days
Babies (6weeks-24 months) FULL	$200	$178	$156	$134
Toddler (24-36 months)	$180	$158	$136	$114
3-year-olds	$168	$146	$124	$102
4/5-year-olds	$158	$136	$114	$92
School Age (before/after)	$110	n/a	n/a	n/a
School Age (after only)	$80	n/a	n/a	n/a

Children Enrolling: Please enter your child's information below. If you are enrolling more than one child, click "Add another child".*
Parent/Guardian Name*

First NameMiddle NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

My Products*

One Child

Non-Refundable Deposit for One Child

$50.00

Multiple Children

Non-Refundable Deposit for Multiple Children

$100.00

Total

$0.00

Credit Card

Should be Empty: