UC Merced Early Childhood Education Center Application
(Items with * are required.)
After you have completed this initial information gathering, you will be transferred to Payment Collection. Failure to pay will result in your child(ren) REMOVED from this wait list! *

Parent/Guardian
Name: *

Daytime Phone Number: *

Cell Phone Number:
Email Address:
UC affiliation (student or job title if UCM employee):
Parent/Domestic Partner/Guardian
Name:
Daytime Phone Number:
Cell Phone Number:
Email Address:
UC affiliation (student or job title if UCM employee):
Home Address:
State/ Zip/County:
Referred by.
Names and Birthdates of Child(ren) you are interested in enrolling and date you would like to START being considered for entry:
First Child
Name: *

Birth Date: *

Entry Consideration Date *

Second Child
Name:
Birth Date
Entry Consideration Date
Third Child
Name:
Birth Date
Entry Consideration Date
Fourth Child
Name:
Birth Date
Entry Consideration Date
Hours of Care (please indicate the hours you are in need of care for your child):
Monday
Tuesday
Wednesday
Thursday
Friday
Center hours of operation are 7:30 a.m. - 5:30 p.m.. Monday - Friday
The system will now transfer you to Payment Collection. Your child(ren) will be REMOVED from the list if you fail to complete payment!
 

(Items with * are required.)

Input the digits into the box below.

*