ABCD, Inc.
1070 Park Avenue
Bridgeport, CT 06604
Phone: (203) 366-8241
Fax: (203) 394-6175



June G. Malone, PHD
Director of Early Learning

If you'd prefer, you can download and mail our print application:

Please fill out the following information and click on submit at the end of the form. A staff member will call you for additional information and to direct you the child care center nearest you to complete the enrollment process. At that time please bring to your scheduled interview: proof of income, child's birth certificate, child's social security card, health insurance card, physical exam with immunization, and dental exam results or proof of a dental appointment.


Section I - Eligible Child

Services Needed

Child's Name

Date of Birth

Gender


Street Address

Town

State

Zip Code

Home Phone

Cell Phone (Optional)

Work Phone (Optional)

Which area of Bridgeport do you live in?


Primary Language

Secondary Language

English Speaking Ability


Section II - Family Members

Do you currently receive any of the following assistance? (check all that apply)
Energy Assistance Medicaid Health Insurance Food Stamps


Primary Supporting Parent

Relationship to Child

Employment Status (check all that apply): In school Employed


Other Supporting Parent

Relationship to Child

Employment Status (check all that apply): In school Employed


Family Members (list names and ages):


How did you hear about us?