Reibman Hall Children’s Center
2015-2016 Registration Form
Complete upon application and at each new enrollment period.
Child’s Name:
Parent/Legal Guardian (Print):
Parent/Legal Guardian (Signature):
Check One:
Date:
Student
Full Time Faculty / Staff
Part Time Faculty / Staff
Community
Children’s Center Location – Circle One:
Bethlehem
Requested Start Date:
/
Monroe
NCC STUDENT & FACULTY / STAFF
Student Note:
 Must be taking a minimum of 3 credits.
 NCC Course Schedule must be attached to receive student rates and hours.
Choose One:
Full Year – 48 wks. (July 1 – June 30)
Schedule remains the same for the full fiscal year.
Fall Semester – 16 wks. (Aug – Dec)
Spring Semester – 16 wks. (Jan – May)
Semester Enrollment - A new registration form needs to be
completed each semester.
Weekly Schedule Options
Choose One – Mark “X” in the box
5 full days
3 full days
2 full days
5 half days
3 half days
2 half days
M thru F – up to 50 hrs./wk.
M/ W / F – up to 30 hrs./wk.
T and R – up to 20 hrs./wk.
M thru F
AM1
PM2
M/W/F
AM
PM
T and R
AM
PM
Summer Semester Options Below
Choose One:
Summer I Semester – 6 wks. (May – June)
Summer II Semester – 6 wks. (July – August)
Semester Enrollment – A new registration form needs to
be completed each semester.
5 full days
4 full days
3 full days
2 full days
2 full days
5 half days
4 half days
3 half days
2 half days
2 half days
M thru F – up to 50 hrs./wk.
M thru R – up to 40 hrs./wk.
M/ W / F – up to 30 hrs./wk.
M and W – up to 20 hrs./wk.
T and R – up to 20 hrs./wk.
M thru F
AM
PM
M thru R
AM
PM
M/W/F
AM
PM
M and W
AM
PM
T and R
AM
PM
1
AM care hours are between 7:30 am and 12:30 pm / 2PM care hours are between 1:00 pm and 6:00 pm.
COMMUNITY
Full Year – 48 wks. (July 1 – June 30)
Schedule remains the same for the full fiscal year.
Weekly Schedule Options
(Choose One)
5 full days
3 full days
2 full days
M thru F – up to 50 hrs./wk.
M/ W / F – up to 30 hrs./wk.
T and R – up to 20 hrs./wk.
NCC Children’s Center values diversity and seeks families and staff from diverse backgrounds. The Center does not discriminate on the basis of race,
color, sex, sexual orientation, religion, national or ethnic origin, age, disability, or status in its activities or employment practices.