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Child Enrollment Request Form
Please fill out the report below
AND
call us at (336)226-7200 to find out more about our current availability/waitlist statuses. We can't wait to hear from you!
*This is not a registration form or application*
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* Indicates required question
Email
*
Your email
Parent/Guardian Name
*
Your answer
Phone Number (format: xxx-xxx-xxxx)
*
Your answer
What type of care do you need? (select all that apply)
*
Full Time Daycare (6mos-4years)
Before/After School (5-12years)
Summer Camp (5-12 years)
Required
Number of enrollees
Choose
1
2
3
4
5
6
Child's Name (Enter all names if multiple enrollees)
*
Your answer
Age (If multiple, enter in same order as names)
*
Your answer
Requested Start Date
*
MM
/
DD
/
YYYY
Payment Type
*
Private Paying
Voucher
Submit
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