Child care

Interest form

Thank you for your interest in Portland Community College’s Child Development 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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Ex. Fall 2023
Which term are you interested in enrolling your child?*
(We do not have a summer program currently)
Are you interested in part time or full time?*
How many days are you interested in?*
Will you be using either of the following?

Child information

Name*
Date of birth*
If pregnant, include projected baby due date
Gender*
Does your child have any special needs?*
Does your child have any allergies or dietary restrictions?*

Parent/Guardian information

Parent/Guardian Name*
Are you a*
Address*

Secondary Parent/Guardian information

Name

Optional

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