Stars for Life Childcare Inquiry Form
Please complete the form below to express your interest to register your child with us. We will contact you as soon as possible to discuss available options and further details.
Parent Name
First Name
*
Last Name
*
E-mail
*
Phone
*
Your Location:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Name:
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
What days do you require daycare?
*
All week
Monday
Tuesday
Wednesday
Thursday
Friday
Daycare Time Requirements:
*
Full Time
Part Time
Morning
Afternoon
Has your child attended daycare before?
Yes
No
Preferred start date:
*
-
Month
-
Day
Year
Date
How did you hear about us?
Message
Submit
Should be Empty: