Please fill out child care registration form completely. Fields marked with * are required.
Start Date: *
Child Name: *
Child Age: *
Child's DOB:
School:
Mother/Guardian Name: *
Mother/Guardian Email: *
Mother/Guardian Phone Number: *
Father/Guardian Name:
Father/Guardian Email:
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.
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