Five Star Life Early Learning Academy Pre-Enrollment Application

Five Star Life Early Learning Academy Pre-Enrollment Application

Full time and part time enrollment for ages 1-5
574-329-5571

10961 Edison Rd, Osceola, IN 46561
Status
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 2 Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Name(s), Age(s) and Birthdate(s) of Child/Children:*
Has your child/children been in child care before?*

YesNo
If "YES", where?
Phone Number of care provider:
Reason for leaving child care center:
Hours/Days needed (part time based on availability):*
Put TBD if unsure of schedule needed.
Anticipated start date?*

MonthDayYear
Date
What is the best time of day for a tour?

Hour Minutes

AM/PM Option
Five Star Life Early Learning Academy is an unlicensed, registered child care ministry in the state of Indiana.
Should be Empty:

574-329-5571