Interest form

Child care

Thank you for your interest in Portland Community College’s Child 欧洲杯决赛竞猜app_欧洲杯足球网-投注|官网ment Center!

Your child’s name will be placed on our waiting list by date of application
If you are applying before your child is born, you must contact the center when the baby is born, with the child’s name and birth date.
Children must be 3 months old by September 1 in order to be eligible for our infant program.
It is your responsibility to notify the Center of any changes made on the information provided above.
To remain on the wait list, it is your responsibility to contact this office by May 30 each year. If you do not contact us, your application may be dropped from our wait list.

"*" indicates required fields

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Which term are you interested in enrolling your child?*

Ex. Fall 2023

Which term are you interested in enrolling your child?*

(We do not have a summer program currently)

Fall 2024

Winter 2025

Spring 2025

Are you interested in part time or full time?*

Part time (7:30am-12pm)

Full time (7:30am-4pm)

How many days are you interested in?*

2 Days: Tuesday/Thursday

3 Days: MWF

4 Days: M-TH

5 Days: M-F

Will you be using either of the following?

CCAMPIS

ERDC

Child information

Name*

First Last

Date of birth*

If pregnant, include projected baby due date

Gender*

Male

Female

Non-binary

Does your child have any special needs?*

Yes

If yes, please specify

example: speech delay, traumas, etc.

Does your child have any allergies or dietary restrictions?*

Yes

If yes, please specify

Parent/Guardian information

Parent/Guardian Name*

First Last

Are you a*

PCC student

PCC student receiving PELL assistance

Military-connected student

PCC faculty or staff member

G Number*

PCC email*

Address*

Street Address Address Line 2 City State ZIP Code

Primary phone*

Alternate phone

Campus phone extension

Planned course of study

Expected term and year of graduation/transfer

Secondary Parent/Guardian information

Name

First Last

Phone

Optional

How did you hear about the Child 欧洲杯决赛竞猜app_欧洲杯足球网-投注|官网ment Center?

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Phone

This field is for validation purposes and should be left unchanged.

Portland Community College | Portland, Oregon

Child care

Interest form

Child information

Parent/Guardian information

Secondary Parent/Guardian information

Optional

Enrollment process