Preschool Inquiry Form and Tour Scheduler

1
Parent Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Please enter a valid phone number.
3
Email* This field is required.
example@example.com
4
Child Name* This field is required.
First Name
Last Name
5
Child's Date of Birth* This field is required.
Date
Year
Month
Day
6
Child's Gender* This field is required.
Please Select
Please Select
Male
Female
7
What is your desired start date?
Date
Year
Month
Day
8
Please select if you will be self pay or if you have funding from ELC.
Please Select
Please Select
Self Pay
Early Learning Coalition - School Readiness Voucher
VPK Voucher
9
Has your child ever been suspended, expelled or asked to withdraw from another school?* This field is required.
YESNO
10
Please provide more details:
Huge
Large
Normal
Small
Ok
Ok
11
Has your child ever been tested or received special assistance for academic, behavior, emotional or attention difficulties?* This field is required.
YESNO
12
Please provide more details:
Huge
Large
Normal
Small
Ok
Ok
13
Should be Empty: