Young Explorer's Care Registration

1

Please provide your full name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

How many children are you considering enrolling?* This field is required.

5

Child(ren) first and last name(s)* This field is required.Please separate by comma or one per line

6

How soon are you looking to start?* This field is required.

7

What hours are you looking for?* This field is required.

Start Time

End Time

8

When would you like to tour our facility?* This field is required.

9

Do you receive Government assistance for childcare payments?* This field is required.

YESNO

10

Are you looking for after school care?* This field is required.

YESNO

11

Are you looking for evening care?* This field is required.

YESNO

12

Are you looking for summertime care?* This field is required.

YESNO

13

Is your child coming from another daycare?* This field is required.

YESNO

14

What daycare are you transitioning from?