• Enrollment Application

  • Thank you for your interest in applying. Please complete and submit this enrollment application at your earliest convenience. Please note there is a non-refundable registration fee of $25 registration due immediately upon the submission of this form.

  • Child’s Demographics

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    Pick a Date
  • Parent Information

    Mother's Information
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  • Please provide us your work location, number and best ways to reach you when you are at work.
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  • Parent Information

    Father's Information
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  • Please provide us your work location, number and best ways to reach you when you are at work.
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  • Emergency Contacts

    In the event of an emergency when you can not be reached, the learning center may contact the following individuals whom are also authorize to take your child from the child care premises in cases of emergency. Contacts listed must be able to provide transportation.
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  • Transportation Plan/ Authorized Pick-up

    Please let us know how your child will be arriving and departing the center.
  • Authorized Pick-Up

    Please provide a list individuals who are authorized to take your child from the center's premises, in the event that you can not pick up your child.
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  • Anticipated Days & Time of Attendance

    Hours of Operation 7:00am-5:00pm
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  • Clear
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    Pick a Date
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  • Should be Empty: