Please fill out child care registration form completely. Fields marked with * are required.
Start Date: *
Child Name: *
Child Age: *
Mother/Guardian Name: *
Mother/Guardian Email: *
Mother/Guardian Phone Number: *
Father/Guardian Phone Number:
Child Care Plan: (Select One) *
Full Day Care ($155 /week)*Daily ($37.50 /day)
*Discount available for ELC Clients and current clients.
**Only available to ELC Clients. Subject to one year contract with two weeks vacation.