ExCEL Development Center Pre-Registration Form
Your Name
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First Name
Last Name
Primary Phone Number
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Area Code
Phone Number
Primary Email Address
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Your Child's Name
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First Name
Last Name
Your Child's Date of Birth
*
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Month
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Day
Year
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What date would you like your child to start?
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Month
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Day
Year
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Which program are you most interested in?
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Infant Care (6 weeks-18 months)
Toddler Care (18 months-35 months)
Intro to Pre-K (3 year old)
Full-Day Preschool + Childcare (M-F)
Half-Day Preschool 9:00am-12:00pm (M-F)
2-Day Preschool + Childcare
3-Day Preschool + Childcare
Before School Care (School Ages K-12 yrs)
After School Care (School Ages K-12 yrs)
Before & After School Care (School Ages K-12yrs)
CampEnergy™ (Science Summer Camp)
Other
Is there any additional information that you'd like us to know?
Submit
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