Please print out this page, fill it in and mail it to:
Cornerstone, 16 Hickory Street, Trumbull, Ct. 06611
A non-refundable fee of $55.00 must accompany this application for full or permanent part time applicants. An annual fee of $25.00 dollars for Flex applicants. Please send a check or money order.
Date
Child's Name
Sex
Address
Age
Date of Birth


Mother or Guardian
Name
Home Address
Home Phone
Employer
Address
Work Phone
Father or Guardian
Name
Home Address
Home Phone
Employer
Address
Work Phone
If you will be paying Cornerstone with a personal check, also complete the following for each person who will be making checks to us during your child's tenure.
Date of Birth
CT. Driver's
License
Date of Birth
CT. Driver's
License


Desired Starting Date
Schedule: Days
Hours

Copyright © 1999 cornerstonekids.com ™ Inc, All Rights Reserved