Child Care Inquiry Form

Child Care Inquiry Form

Closing the Gap Learning Center Parent Inquiry
Parent/Guardian Name*

First NameLast Name
E-mail*
Contact Number*

Child's Name

First NameLast Name
Date of Birth

MonthDayYear
School District

Attendance: tick the days you would like your child to attend.

Rows	AM	PM	SCHOOL HOLIDAYS
Day term time
Monday
Tuesday
Wednesday
Thursday
Friday

Start Date

MonthDayYear
More details
Should be Empty: