Title: The Child and Family Development Center

225 S. 1400 E., Rm 228
Salt Lake City, UT 84112
Phone: (801) 581-6521
Fax: (801) 581-5156

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CFDC APPLICATION

Child's Information
*Child's Name:	*Birthdate (mm/dd/yy):
*Gender:	Number of siblings:
*Address:	Address Cont.:
*City:	State: Zip:
*Home Phone:	Email:

*First Parent's Information
*Name:	Ethnicity:
Birthplace:	Marital Status:
Occupation:	Work Phone: Cell Phone:
Hrs/week at work:	Education:

Second Parent's Information
Name:	Ethnicity:
Birthplace:	Marital Status:
Occupation:	Work Phone: Cell Phone:
Hrs/week at work:	Education:

Affliation with the University of Utah:
*Child currently in our program: Yes No
Date parent(s) visited CFDC:
Any special needs or comments about this child:

*Required Field

*Entering Semester :
Please choose a 1st, 2nd, and 3rd choice (if applicable)
tuition prices are subject to change
CHOICE							TUITION (COP-OP / NON CO-OP)
1st	2nd	3rd	CLASS	AGES	DAYS	TIMES	Monthly (9/year)	or Per Year
			Toddler AM	24-36 Months	T & Th	9:00-11:00	$110.00 / $125.00	$990.00 / $1125.00
			2 Day AM	3-Years	T & TH	9:15-11:30	$127.00 / $141.00	$1143.00 / $1269.00
			3 Day AM	3-5 Years	M, W, F	8:30-11:20	$181.00 / $204.00	$1629.00 / $1836.00
			5 Day PM	4-5 Years	M-F	1:00-3:50	$242.00 / $278.00	$2178.00 / $2502.00
			4 Day PM	4-5 Years	M-Th	1:00-3:50	$219.00 / $248.00	$1971.00 / $2232.00
			Kindergarten	5 Years By 11/1	M-F	1:10-4:00	$242.00 / $278.00	$2178.00 / $2502.00
			Extended Hours - (After Hours Program)
			5 afternoons	4-5 Years	M-F	3:50-5:15	$155.00 / $155.00
			4 afternoons	4-5 Years	M-Th	3:50-5:15	$125.00 / $125.00