Enrollment Interest Survey
Please fill out the information below and we will contact you soon!  Thank you for your interest in St. Peter's Lutheran Early Childhood Center!  
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Today's Date *
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Parent name(s) *
Address (Street, City, State, Zip Code) *
Email Address *
Phone Number(s) - cell/home *
Best time to reach you
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Please list your child(ren)'s name(s) and date of birth (month/day/year) *
For each child listed above, please share his/her current center/program or any others they have attended.   *
For each child listed above, please share the following:
Full time or part time care?
Which days and/or how many days per week?  
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Any special learning needs?
Is your child potty trained?  Please state "Yes" or "No" along with child's name.   *
Is there anything else you'd like to share with us about your child(ren)?  
How did you hear about St. Peter's Lutheran Early Childhood Center?   *
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