LDCC Children's Center Application

Date Date / MM / DD YYYY
Name of Child Name of Child First Last
Age
Birth Date Birth Date / MM / DD YYYY
Potty Trained
Parent/Guardian Information
Other Parent/Guardian Informaiton
Name Name First Last
Address Address
Street Address City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Job title/position:
Please select one

Please select one Student at LDCC Faculty at LDCC Staff at LDCC Community
Other Parent/Guardian Information

Please include any information for an additional parent or guardian
Relationship to the child
Name Name First Last
Address Address
Street Address City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Job title/ position:
Please select one

Please select one Student at LDCC Faculty at LDCC Staff at LDCC Community
Tuition Information:
LA Delta Children’s Center is CCAP approved!
5 days (4 full & 1 half day): $105
1 full day: $25
Half Day (4 ½ hours or less/no lunch): $15

Hours of Operation:
Monday – Thursday: 7:45 A.M. – 4:30 P.M.
Friday: 7:45 A.M. - Noon

Louisiana Delta Community College does not discriminate in its education and employment programs on the basis of religion, age, race, color, national origin, gender, marital or parental status, or disability, and complies with Title VI of the Civil Rights Act of 1964, Title IX Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990.