Child Enrichment Center

Child
Enrichment
Center

CHILD ENROLLMENT FORM

The new State-of-the-art Child Enrichment Center will be slated to open on or before September 30. The Center will be open Monday through Saturday from 5:00 a.m. to 9:00 p.m. (if there is a great demand the second shift care, hours may change to 11:00 p.m.). The Center will be equipped with computers for the children to learn and Internet Viewing for parents, guardians and distant relatives (utilizing the PEEK-A-BOO Webcam’s).

Space will be limited and interested parents are encouraged to enroll their children in advance. Please fill out the below information and a center representative will be in contact with you very soon. THANK YOU!

FAMILY INFORMATION

Parent’s Name:
Address:
City, State, Zip:
Home Phone Number:
Work Phone Number:
Child’s Name:
Child’s Date of Birth:
Child’s Name:
Child’s Date of Birth:
NEW PARENTS TO BE SECTION
Expected Date of Birth:
CARE INFORMATION
Full Time Care Part-time Care Before School Care After School Care Evening Care (4-9 p.m.) Second Shift Care (9-11 p.m.)