[Revised 8/2016]

Marshall Child Development Center, Inc.

Voting Membership Application

Marshall Child Development Center, Inc. (MCDC, Inc.) was created for the purpose of providing quality, reasonably priced childcare and education.

I, [ insert name here ], am applying for voting membership in MCDC, Inc. I certify that I qualify for membership as either a NASA employee or retiree, an MCDC employee, an on or off-site contractor at MSFC, the Redstone family or the spouse of such. As the parent, grandparent, or legal guardian, I wish to have my child/children enrolled in or placed on the waiting list for the MCDC. By submitting this form to MCDC, I agree to pay an annual fee, set each year by the corporation’s Board of Directors, and to abide by the by-laws of the Corporation.

Applicant Info
Parent/Guardian Name:
Sponsor Name (for Grandparent): / Currently Enrolled: Yes:☐ No:☐
Application for:
Full-time Care:☐ Drop-in Only:☐
Qualification (check one): / Qualification (check one)
☐NASA Civil Servant
☐NASA Retiree / ☐NASA Contractor ☐ Redstone Family
☐MCDC Employee / ☐Parent
☐Grandparent
☐Legal Guardian
Employer: / Work Phone:
Email Address: / Home Phone:
Alt e-mail address: / Other Phone:
Alt contact Info (e.g. spouse, family member, etc)
Name: / Work Phone:
Email Address: / Home Phone:
Alt Email address: / Other Phone:
Waitlist/Drop-in Daycare Info
Child #1 DOB or Due Date:
Child #2 DOB or Due Date: / Desired Start Date (if space available):
Check here if you wish to be listed as “Anonymous” on the list? ☐

------Completed by MCDC ------

Date Received: / Date Removed from Waitlist:
Dues Paid: Yes☐ No☐ / Enrollment Date:
Cash☐ Check No. / Notes:
Date Entered into System:

MCDC

P. O. Box 9138 Initials ______

MSFC, AL 35812

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