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This application is for IU Bloomington Childcare Centers only. If you need childcare in Indianapolis, please visit their website.

Child's First Name

Child's Last Name

Child's Gender

Child's DOB

If pregnant, please enter Expected Due Date in place of Date of Birth.

Primary Parent/Guardian First Name

Primary Parent/Guardian Last Name

Primary Parent/Guardian Email

Confirm Primary Parent/Guardian Email

Primary Parent/Guardian Phone Number

Please type phone number without dashes or parentheses (Example: 18121234567)

IU Affiliation

Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian Email

Secondary Parent/Guardian Phone

Please type phone number without dashes or parentheses (Example: 18121234567)

Facility Selection

Please select your facility preference(s) below using the drop down arrow. You may select more than one option.

HCNS Schedule (Required if HCNS is Selected Above)

Please select your HCNS schedule preference(s) using the drop down arrow. You may select more than one option.

Enter the code from the image