Knee High Day Care Cooperative -- Membership Application

APPLICATION FOR MEMBERSHIP
KNEE HIGH DAY CARE COOPERATIVE
702 E. Cottage Grove
Bloomington, IN
855-0150

We are currently taking applications for children to begin Summer II or Fall 2006..

Before completing this application, we strongly suggest that you first visit us with your child, and that you take the time to read through the INFORMATION FOR APPLICANTS TO KNEE HIGH. In addition, please remember the criteria for membership: you must be IU faculty, student or staff; your child must have the standard immunizations; and you must be prepared to meet the shift, financial, administrative and cleaning duties of a member.

Name(s) of Parent(s):

Email:

Date you would like to begin:

Address:

Phone Number:

University affiliation(s):

Child or children's date of birth:

Names and ages of children, and a short description of each child. Please include any special medical or other needs:

Please describe any experience you have had in a cooperative setting.

Please describe any work you have done with children in a group.

Why are you interested in Knee High?

If accepted into Knee High, how long do you plan on staying?

What special activities would you be interested in organizing?

Please list one personal reference who can speak to your ability to work with children:
Name:	Phone:	Email:

Last Modified: Oct 14, 2003 9:06am