Childcare Center Pre-Registration Form

Pre-Registration Form

Thank you for your interest in Lansing Learning Tree CCC
Located at 5225 S. Waverly Rd Lansing, MI 48911

We are pre-registering children ages 3-5 years old . Please complete the form below and we will contact you for an interview to discuss your childcare needs and our philosophy. Space is limited so don't delay! If enrolling more than one child please leave names and birthdays in the comment box. Please feel free to contact us by email at Lansinglearningtree@gmail.com. If you have any additional questions. We look forward to serving your family. Thank you!
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
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
Exceptional Childcare Needs
Additional Comments
If not full-time, please indicate preferred schedule.
Should be Empty:

Pre-Registration Form