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Childcare Inquiry Form
Help us get to know you and your family better! What are your childcare needs? Please fill out all the required spaces below.
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Email
*
Your email
Parent's Contact Information: Full Name, Home Address, Cell Phone Number and Email
*
Your answer
Child's Name
*
Your answer
Child's Date Of Birth & Age
*
Your answer
Do you have other children? If so, complete below with same information as above: (Child's Name, DOB and Age)
*
Your answer
What type of schedule are you looking for?
*
Full Time (5 days a week)
Part time (2-4 days a week)
Part Day (3-5 hours per day)
Drop In (varied days/hours)
For School Age Children ONLY: Where does your child go to school?
Your answer
For tuition payment: Would you be paying cash (out of pocket) or using the DCFS Subsidy for childcare for low income families?
*
Cash
DCFS
Not sure, tell me more!
Are there additional parents or contacts you'd like to mention? Please do so below. (Name, Phone, Address)
Your answer
2020 Tuition Rates
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