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
Male
Female
Other
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 Center
Aftercare School Ages infant to 13 and Under
Both
Subsidy: Do you have Program for Parents or 4C's?
*
Yes
No
Are you interested in?
*
Before Care (6:30am to 8:00am)
Aftercare (Between 3:30pm and 9pm)
Both
Not sure
Do you need transportation (an additional cost of $125 per week) within 4 miles of Center's Location ?
*
Yes
No
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?
*
Sign
Flyer
Google/Other search engine
Facebook
Friend
Winnie.com
Other
Other Here
Submit
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