High-light, print application and mail it   
with the (nonrefundable) $75.00
application fee to:

Avondale Children's Center
2821 Park Road
Charlotte, NC 28209

          Thank-you!
                                            
                                                 PRELIMINARY APPLICATION




Due Date (if applicable) ____________________________________________________
Date Space is needed______________________________________________________

Would be willing to pay to hold space _______yes _______no
Child’s Name ____________________________________________________________
Date of Birth ____________________________________________________________
Home Address ___________________________________________________________
     __________________________________________zip _______________
Fax # ___________________________________________________________________
Home # _________________________________________________________________

Mother’s Name __________________________________________________________
(or Guardian)
Business ________________________________________________________________
Business Phone ____________________________________

Father’s Name ___________________________________________________________
(or Guardian)
Business ________________________________________________________________
Business Phone ____________________________________

Are you a member of Avondale Presbyterian Church? ____________________________

Do you have a child currently enrolled at Avondale Children’s Center? ______________
If yes, please give name and age. _____________________________________________
Has your child had group experience? _________________________________________
If so, beginning at what age? ________________________________________________
Is your child currently in a group experience? ___________________________________

If your family is not affiliated with a church, would you be interested in hearing from a representative of
Avondale Presbyterian? ________yes _________no



-------------------------------------------For office use------------------------------------------------


Date of Application ____________________________________
Fee Paid _____________________________________