LINA'S LEARNERS CHILDCARE WAITLIST INQUIRY
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Email *
Are you okay with placing your child in a home-based childcare? *
Required
What hours of care do you need? 
(Lina's Learners hours are 7:00am-5:30pm, Monday-Friday.)
 *
What is your Name and Phone Number?
Our program is an Infant/Toddler/Pre-K Program (ages 6 weeks-3 years old). Is your child in this age group?  *
Required
What is your child's age?
 *
What date are you looking to start care? Please select date below. *
MM
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Has your child been in childcare before? *
Has your child ever been terminated from a childcare program? *
Will you be cash pay or voucher pay (CCDF)? *
Required
Is your child current on childhood immunizations? 
Will you be able to provide proof and the child's physical?
 *
Required
Will this be for short-term or long-term childcare? *
Does your child have any special needs, require accommodations, dietary restrictions, or religious preference? *
Does your child nap? *
Are you seeking Full-Time (3-5 days/25 or more hours) or 
Part-Time (2 days/less than 25 hrs) care?
 *
Is your child able to communicate one's needs or are they non-verbal (Ages 2-3)? *
Is your child able to sit to learn or are they always on the go? (Ages 2-3) *
Why are you currently seeking childcare? *
Required
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