Childcare Enrollment Inquiry

All registrations are received and reviewed in a first-come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list and you will receive a letter.

First Name

Last Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Phone Number

Area CodePhone Number

First Name

Last Name

Child DOB

MonthDayYear

Which program would you like to enroll in? (Select One)

Expected Start Date

First Name

Last Name

Child DOB

MonthDayYear

Could you briefly share how you heard about our program?

Would you like to add more children? If so, please enter their information in the box below.

Questions / Comments: Please read below

*If you are inquiring about our After-School Care Program, provide the following information above: the #1) Name of your child's school, #2) Dismissal time, and whether #3) Transportation arrangements are required.

Please choose a time for a call, Monday–Friday between 11:00 AM and 5:00 PM.

:HourMinutesAM/PM Option

By providing your contact information, you consent to Cecelia’s Little Learners Childcare & Preschool contacting you via phone, text, or email regarding our services.

To prevent any delays in processing your inquiry form, please ensure that all questions are fully & correctly answered and one application is submitted. Thank you!

H

Please verify that you are human

Which program would you like to enroll in? (Select One)

Child Enrollment

Primary Parent Information

Child Information

Child Information #2