Form

First name*

Last name*

Email*

Child First name*

Child Date of Birth*

Please select the location of interest

Please select Full, Extended or Half Day Care

Please select number (#) of days per week needed

If applicable, please select extended hours needed.

AM Care 7:00am-8:30am (Program starts at 6:45 am in Bay Shore & AM Care not available in Glen Cove)

PM Care 4:00pm-6:00pm

AM & PM Care

Please include name(s), DOB, Program desired for each additional child.

Registering Multiple Children in Household for Y Preschool Program