Estes Children's Cottage Application Form
Please complete this form to apply for your child to attend Estes Children's Cottage.  A non-refundable fee of $50 is required to complete your application and secure your child's slot on the waitlist. We will send you an invoice upon receiving this application.  
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Email *
Child's Name (First, Middle, Last) *
Child's Birth Date *
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Child's Sex *
Child's Home Address *
Preferred Phone Number *
Preferred Email Address *
Parent / Guardian 1 Name *
Parent / Guardian 1 - Where employed? *
Parent / Guardian 2 Name (if applicable)
Parent / Guardian 2 (if applicable) - Where employed?
Please describe any previous experience your child has had with group care or caregivers other than a parent *
How did you hear about our program? *
Preferred Start Date *
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How many days of the week would you like your child to attend? *
If you chose 2-4 days please list which are your preferred days of the week.
Would you consider other schedules if your first choice is not available? *
Expected Arrival Time (between 8:00-9:15) *
Expected Departure Time (12:30 or between 3:00-3:30) *
Thank you for your interest in Estes Children’s Cottage!
A copy of your responses will be emailed to the address you provided.
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