ECE Interest Form

Early Childhood Education Center Interest Form

Thank you for your interest in the AJCC ECE! We look forward to connecting with your family
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Communication Preference
What type of care are you looking for*

Full timePart timeParent & Me
How did you hear about us?

Current school familySocial MediaAdvertisementWord of mouthFormer AJCC parentOther
Which program are you interested in?*

J Baby (Parent & Me, 0 - 12 months)J Tots (Parent & Me, 10 - 24 months)Toddler CareTwosPreschoolPre-KOther
Child 1 Name*
Child 1 DOB/Due Date*

MonthDayYear
Date
Child 2 Name
Child 2 DOB/Due Date

MonthDayYear
Date
What are you looking for in an early childhood program?
If you would like a tour of the ECE, please use the calendar below
If you would like to schedule a tour, please indicate your preferred days/times
Tell us about your child's previous school experience
Is there anything else you'd like to share with us?
Should be Empty:

Early Childhood Education Center Interest Form