The Creative Clubhouse — Tour Request
Schedule a Tour
We’d love to meet you and show you around! Please complete the information below, and we’ll contact you to confirm your tour.
Thank you for your interest in The Creative Clubhouse LLC. Complete this form to request a tour of our childcare program serving Independence and surrounding areas. We will contact you to confirm availability.
Parent/Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Child’s Name
Child’s Age
Desired Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Alternate Availability
Anticipated Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Questions or Accommodations
I confirm that the information provided is accurate and consent to The Creative Clubhouse LLC contacting me by phone or email regarding my tour request. I understand that submitting this form requests a tour and does not guarantee enrollment or a childcare placement.
*
I confirm that the information provided is accurate and consent to The Creative Clubhouse LLC contacting me by phone or email regarding my tour request. I understand that submitting this form requests a tour and does not guarantee enrollment or a childcare placement.
Care Needed (Select all that apply)
Full-Time
Part-Time
Before School
After School
Overnight Care
School Closure Program
Drop-In Care
Previous and Current Childcare
The Creative Clubhouse LLCnwww.thecreativeclubhouse.orgn866-302-3187nServing Independence and surrounding areas
Has your child attended another daycare or childcare program before?
*
Yes
No
If yes, where did your child attend?
What was the reason for leaving?
Is your child currently enrolled in another daycare or childcare program?
*
Yes
No
Will you be using more than one provider?
Yes
No
If yes, where is your child currently enrolled?
Care Schedule
Days Needed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Care Times Needed
Please list the times you need care on the days selected (e.g., Mon–Fri, 8:00 AM–3:00 PM).
Preferred Tour Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Tour Time
Please Select
9:00 AM
10:00 AM
11:00 AM
1:00 PM
2:00 PM
3:00 PM
Other
How Did You Hear About Us?
Please Select
Google
Facebook
Instagram
Friend or Family
Website
Community Event
Other
Questions or Comments
Payment Information
How will you be paying for childcare?
*
Missouri Child Care Subsidy (State Assistance)
Private Pay (Self-Pay)
Employer Child Care Benefit
Other (Please Specify)
Subsidy Status
*
Approved
Pending
Applying
I understand that I am responsible for a Co-Pay regardless of the sliding fee given by the state of Missouri.
*
I understand and agree
Child Care Subsidy Case Number
Child’s DCN (Departmental Client Number)
Preferred Payment Method
*
Brightwheel Payments
Zelle
Cash
Payment Schedule Preference
*
Weekly
Bi-Weekly
Additional Payment Notes
Tour Reservation Fee
Tour Reservation Fee
*
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Tour Reservation Fee
The Creative Clubhouse LLC — Tour Reservation Fee
$15.00
$
15.00
Credit Card
I understand that a $15 Tour Reservation Fee is required to reserve my tour. This fee is non-refundable if I do not enroll; however, if my child enrolls with The Creative Clubhouse LLC, the full $15 will be credited toward my $50 Registration Fee.
*
I understand my requested tour date and time are not confirmed until I receive confirmation from The Creative Clubhouse LLC.
Photo ID Upload
Photo ID
*
Upload Photo ID
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Choose a file
Please upload a clear copy of your photo ID.
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