Mathisi Academy Interest Form
Thank for your interest in Mathisi Academy! Please fill out the following interest form and submit. We will contact you to schedule a tour or you can drop in and visit us at 5901 Lancaster Ave. Philadelphia, Pa 19151. 267-292-3517
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Confirmation Email
example@example.com
How many children do you need care for?
*
Please Select
1
2
3+
Which of the following days will you need Childcare
*
Monday
Tuesday
Wednesday
Thursday
Friday
Child 1
First Name
Age
Child 2
First Name
Age
Child 3
First Name
Age
When would you need to start childcare?
*
-
Month
-
Day
Year
Date
Private Pay or ELRC (CCIS)
*
Private Pay
ELRC
What date and time would you like to tour the center?
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Is there anything you would like for us to know about your child/children?
*
Submit
Should be Empty: