Childcare Center Pre-Registration Form

WWLA Pre-Registration Form

Thank you for your interest in We are the world Learning Academy!!
Please fill out this pre-registration form to be considered for one of our infant or toddler full and part time spaces. After this form is submitted, we will contact you to schedule an interview to meet your lovely family! We will discuss your childcare needs and our philosophy. Space is limited so don't delay!
Parent #1 Name

First NameLast Name
Parent #2 Name

First NameLast Name
Child's Name

First NameMiddle NameLast Name
Child's Birth Date

MonthDayYear
Child's Gender
More than one child? List name and DOB
Address

Street Address

Street Address Line 2

CityState

Zip Code
Primary E-mail
Secondary E-mail
(optional)
Preferred Start Date
Parent #1 Primary Phone Number

Area CodePhone Number
Parent #2 Primary Phone Number

Area CodePhone Number
Preferred Care Schedule
Preferred Care Schedule hours needed
If not full-time, please indicate preferred schedule.
Exceptional Childcare Needs
Do you currently have title 20?
Should be Empty:

WWLA Pre-Registration Form