Infant - Appointment Request
Select which days work best for you, and we will get back to you.
1. Basic Information:
Child's Details
Child's Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date Of Birth
Any known allergies or dietary restrictions?
*
Yes
No
If yes, please specify:
Has your child been in daycare or preschool before?
*
Yes
No
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1: Parent/Guardian Name(s)
*
First Name
Last Name
2: Parent/Guardian Name(s)
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How Did You Hear About Us?
*
Google Search
Referral from a Friend or Family
Local Community Board (e.g., Nextdoor, Facebook Groups)
Social Media (Instagram, Facebook, etc.)
Online Directory (e.g., Yelp, Care.com)
Other (please specify)
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What are you looking for in a daycare/preschool?
Parent Goals & Expectations
What would you like your child to gain from our the program?
Any specific activities or programs you’re particularly interested in our program ?
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Scheduling a Visit
Appointment
*
Additional Notes or Questions for the Visit
Submit
Should be Empty: