Applications are taken on a first come, first serve basis each March.

No person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination in any program or activity available at The Clarksburg Children's House on the basis of race, color, sex, religion, creed, political belief, age, national origin, linguistic and language difference, sexual orientation, socio-economic status, height, weight, marital or familial status, or disability.

Applications are taken in March of each year and should be returned no later than June. You may apply online here or fill out an application in person. Fill out one per child. You'll be contacted for information on an orientation and emailed our welcome kit, including information on payment schedules. Contact us with any questions or comments.

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Please fill out a separate application for each child.

Child's Name

First Name

Last Name

Child's Birthdate

MM

DD

YYYY

Program

Please select which TCCH program this child if applying for.

Parent or Guardian's Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Preferred Phone Number

(###)

###

####

Areas of Concern or Special Needs

Preferred Method of Communication