Enrollment Application - Williamsburg Campus Child Care

Today's Date *

Desired Start Date *

How Did You Hear About WCCC

Name of Referring Family

Other

Child's Last Name *

Child's First Name *

DOB/Due Date *

W&M Affiliation *

Gender *

Siblings at WCCC

Child's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Parent/Guardian 1 Last Name *

Parent/Guardian 1 First Name *

Parent/Guardian 1 Primary Phone *

Parent/Guardian 1 Secondary Phone *

Parent/Guardian 1 Email *

Parent/Guardian 1 Address *

Same as Child
Different

Parent/Guardian 1 Address if Different than Child

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Parent/Guardian 1 Employment Status *

Parent/Guardian 1 Place of Employment/Study *

Parent/Guardian 2 Last Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Primary Phone

Parent/Guardian 2 Secondary Phone

Parent/Guardian 2 Email

Parent/Guardian 2 Address

Same as Child
Different

Parent/Guardian 2 Address if Different Than Child

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Parent/Guardian 2 Employment Status

Parent/Guardian 2 Place of Employment/Study

Checkboxes

In the event that my family is no longer interested in enrolling in WCCC, I certify that I will notify the Center in writing by emailing wccc@wm.edu If I am notified of an available space, I will respond within 48 hours or the space may be released to the next available family.

Application Fee

A $52 non-refundable fee is required to finalize your application. The application fee does not guarantee enrollment. Once you click 'Submit' below, you will be automatically directed to PayPal.

Single Item

Price: $ 52.00

Total

360.00