Salford Mennonite Child Care Centers

Important information about our childcare application:

480 Groff’s Mill Road.
Harleysville, PA 19438

Your child’s name will be placed on the waiting list, and all attempts will be made to accommodate your desired beginning date.
Upon Enrollment, tuition payments are due on Mondays.
If you would like to download this application, you may do so here: Child Application

Application:

Name of Child
Birth Date or Due Date
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother / Legal Guardian Information
Mother's Name / Legal Guardian
Mother / Legal Guardian Home Phone
Mother / Legal Guardian Cell Phone
Mother / Legal Guardian Email
Mother / Legal Guardian Address (If different than child's)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's Employer
Mother's Employer Phone
Mother's Employer Email
Father / Legal Guardian Information
Father / Legal Guardian Name
Father / Legal Guardian Home Phone
Father / Legal Guardian Cell Phone
Father / Legal Guardian Email
Father's Address (If different from child's)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father's Employer
Father's Employer Phone
Father's Employer Email
Child Information
Names and Birth Dates of Sibblings
Are you the child's
- Biological Parent
- Adoptive Parent
- Legal Guardian
Unusual Factor in Child's Life
- Absence of father or mother
- There is a court order affecting this child
- Third Choice
Previous nursery school or child care attended (if applicable)
How did you hear about our center?
Hours
Check Contract Hours
- 8.5 hours
- 9 hours
Please note: Any schedule in excess of nine hours daily will be charged over time.
Desired Beginning Date?
Comments

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