Fall Enrollment
Fall Date of Enrollment is Sept 3rd,2024
Parent Information
First Name
Last Name
Email
Phone
Child Information
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Add Additional Child
Fall Date of Enrollment is Sept 3rd,2024
Desired Start Date
Desired End Date
How many days per week?( 3 day minimum)
3
4
5
Desired hours of care ( available 6am-6pm)
Additional Information
Form of Payment
State Funded
Private Pay
Does your Household Income fall at or below 200 percent of the Federal Poverty Level (FDL)?
Yes
No
Message
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