Boston College Children's Center Lottery Application

Boston College Children's Center

Lottery/Wait List Form for Class of 2013

Boston College Children's Center

Haley Carriage House, 47 Stone Avenue, Chestnut Hill, MA 02467

(617) 552-3089 (Office)

(617) 552-4284 (Fax)

The lottery submission date has passed but you are welcome to apply to our current wait list and you will be contacted by BCCC regarding the status of applications and the wait list once you submit.

We recommend using Internet Explorer to fill out this form.

PLEASE NOTE: An asterisk next to the form field indicates that information in that field is required. The form will not submit correctly if a required field is left blank.

Child FirstName

Please enter the first name of the child.

Child LastName

Please enter the last name of the child.

Child Date of Birth

Please enter the date of birth of the child above as MM/DD/YYYY. Cannot be later than 12/31/2010.

Child Age on September 1, 2013 in years and months

Must be at least 2 years 9 months

Child Gender

Female

Male

Previous childcare placement:

Please indicate any previous school, program or homecare.

NOTE: For the "Parent" information below, please enter information about the BC-affiliated parent for Parent 1. Please substitute Guardian information if applicable.

Parent 1 First Name

Please enter the first name of Parent 1.

Parent 1 Last Name

Please enter the last name of Parent 1.

Parent 1 Home Address

Please enter the home address (number/street/unit)

Parent 1 Home City

Please enter the home address city.

Parent 1 Home State

Please enter the home address state.

Parent 1 Home Zipcode

Please enter the home address zipcode.

Parent 1 Phone

Please indicate the best number for contact.

Parent 1 Email address

Parent 1 Business Name

Please enter the name of the business where Parent 1 works.

Parent 1 Business Address

Please enter the business address (number/street/unit) for Parent 1.

Parent 1 Business City

Please enter the city for Parent 1 business.

Parent 1 Business State

Please enter the state for Parent 1 business.

Parent 1 Business Zipcode

Please enter the zipcode for Parent 1 business.

Parent 1 Business Phone

Please enter the phone number for Parent 1 business.

Parent Primary Relationship to Boston College (choose one):

Faculty

Support Staff

Professional/Administrative

Service/Technical

Graduate Student

Undergraduate Student

Neighborhood Resident

If BC Employee, indicate status:

Full-Time

Part-Time

Not a BC employee

If BC Student, indicate status:

Full-Time

Part-Time

Not a BC student

If BC Employee or Student, would you like tuition assistance information?

Yes

Not a BC employee or student

Parent 2 First Name

Please enter the first name of Parent 2.

Parent 2 Last Name

Please enter the last name of Parent 2.

Parent 2 Home Address

Please enter the home address (number/street/unit)

Parent 2 Home City

Please enter the home address city.

Parent 2 Home State

Please enter the home address state.

Parent 2 Home Zipcode

Please enter the home address zipcode.

Parent 2 Phone

Please indicate the best number for contact.

Parent 2 Email address

Parent 2 Business Name

Please enter the name of the business where Parent 2 works, if any.

Parent 2 Business Address

Please enter the address (number/street/unit) where Parent 2 works.

Parent 2 Business City

Please enter the business city.

Parent 2 Business State

Please enter the business state.

Parent 2 Business Zipcode

Please enter the business zipcode.

Parent 2 Business Phone

Please enter the business phone number for Parent 2.

Please choose from these schedules for September 2013 - June 2014:

Approximate arrival and departure for child at BCCC

(for example, 9 AM - 5 PM)

Notes on schedule flexibility:

Name of person submitting form:

Boston College

Secondary navigation:

Main navigation:

Children's Center Lottery Application

for classes beginning september 2013

Boston College

Secondary navigation:

Main navigation:

Breadcrumb navigation:

Children's Center Lottery Application

for classes beginning september 2013