Parent Full Name
*
Email Address
*
Student's age /infant months
*
Student's/infant Birthday
*
Student's/infant Full Name
Student's/infant Gender
Male
Female
Other
How many children would you like to enroll?
*
Contact Number
*
Address
*
City
*
Zip Code
*
Please Select your Preferred Session
*
T.E.A.C.H. Academy Childcare Center (8:30am to 3pm)
Aftercare School Ages infant to 13 and Under (3:30pm to 8pm)
Do you have programs for parents?
*
Yes
No
Are you interested in?
*
Before Care (7:30am to 8:45am)
Aftercare (Between 3:30pm and 8pm)
Both
Not sure
Do you need transportation (an additional cost of $100 per week) ?
*
Yes
No
If so what time does your child need to be picked up Please be specific.
Where does your child need to be picked up from?
How did you find us?
*
Sign
Flyer
Google/Other search engine
Facebook
Friend
Hometown Values
Other
Other Here
Submit
T.E.A.C.H. Academy Childcare Center & Afterschool Interest Form
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