Application

You may use this form to apply to Zimtor Family Child Care. On receipt of the application, I will schedule you for a parent interview and your child for a one-day classroom visit to Zimtor. You may observe your child’s visit but not participate. Following the interview and visit, I will either make an offer of admission or explain why your child is not eligible for admission.

Required fields are marked with an asterisk.

All personal information collected on this form, as well as any personal information collected in the course of providing child care services, is kept in strict confidentiality. All personal information is kept in encrypted form on Zimtor's personal computer or cell phone.

You may also download the form as a fillable PDF. Not all PDF readers support the fillable feature, but most do. Download Application (521 KB)

Child

Name*
Birthdate*
Start date*

Is your child toilet trained?*
Yes No
Other than Covid, will your child have all immunizations specified in the Centers for Disease Control schedule by the start date?*
Yes No

First Parent

All school communication will be directed to the contact information in this section.

Name*
Email*
Phone*
Street 1*
Street 2
City*
State/Province*
ZIP/Postal Code*
Country*
How did you learn about Zimtor?

Second Parent

Name
Email
Phone

Address Same as First Parent

Street 1
Street 2
City
State/Province
ZIP/Postal Code
Country