The Toddler Learning Center Interest Form
Please complete this interest form if you are interested in enrolling your child/ren at the The Toddler Learning Center of Community Initiatives Inc. The Toddler Learning Center provides care for children ages 2-4. If enrolling more than one child, please complete one entry for each child.
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Child's Name  *
Child's Date of Birth  *
MM
/
DD
/
YYYY
Child's Age *
Parent/Guardian Name *
Parent/Guardian Relationship *
Parent/Guardian Contact Number  *
Parent/Guardian Email
 Address *
Are you employed?
Clear selection
Are you a student? (High School or College)
Clear selection
Do you receive or is your child eligible for Medicaid?
Clear selection
Do you have your own personal transportation?
(Transportation may be provided, with identified need)
Clear selection
Additional Questions/ Concerns
Submit
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