T.E.A.C.H. Academy Childcare Center & Afterschool Interest Form

T.E.A.C.H. Academy Childcare Center & Afterschool Interest Form
Parent Full Name*
Email Address*
Contact Number*
Student's age /infant months *
Student's/infant Birthday*
Student's/infant Full Name
Student's/infant Gender

MaleFemaleOther
How many children would you like to enroll?*
Home Address*
City*
Zip Code*
Please Select your Preferred Service*

T.E.A.C.H. Academy Childcare CenterAftercare School Ages infant to 13 and UnderBoth
Subsidy: Do you have Program for Parents or 4C's?*

YesNo
Are you interested in?*

Before Care (6:30am to 8:00am)Aftercare (Between 3:30pm and 9pm)BothNot sure
Do you need transportation (an additional cost of $125 per week) within 4 miles of Center's Location ?*

YesNo
If so what/s the latest time your child could be picked up. Please be specific.
Where does your child need to be picked up from?
How did you find us?*

SignFlyerGoogle/Other search engineFacebookFriendWinnie.comOther
Other Here
Should be Empty: