Lucy Brock Child Development Laboratory Program (LBCDLP) Application

Child's Name
Home Address
Father
Mother

Names, gender, birth dates; please indicate if siblings attended LBCDLP.

Please indicate any allergies. Also list any identified disabilities, delays in physical, mental, emotional development, and/or any other diversity considerations. LBCDLP is inclusive and actively seeks to increase diversity in the groups of children served.

The infant/toddler room serves children from birth to 3 years of age; the preschool room serves children from 3 through 5 years of age. Your child's name will be placed on our waiting list; please be aware that decisions made regarding placement are based on a multitude of factors, not necessarily order on the waiting list.

Please remember to update your information when changes in address or telephone number occur. If you are submitting an application for an unborn child, it is important that you update the information (name, gender, date of birth) when the child is born. Failure to update your application may result in removal of your child from the waiting list.

Signature of person making application