Parent Full Name
*
Email Address
*
Student's age /infant months
*
Student's/infant Birthday
*
Student's/infant Name
Student's/infant Gender
Male
Female
Other
Student's /infant Birthday
How many 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 (3:30pm to 8pm)
Both
Not sure
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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