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Early Learning Center, Inc. Enrollment
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Email *
Child's Name (First & Last) *
Child's Pronouns
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Birth Date/Due Date *
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DD
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YYYY
Check the age group(s) you're interested in care for:
 *
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Parent/Caregiver Name (First & Last) *
Parent/Caregiver Pronouns
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Parent/Caregiver Phone Number:
*
Parent/Caregiver Name (First & Last, Pronouns)
Parent/Caregiver Contact Information: Please provide your Email and/or Cell Phone Number. Our Enrollment Coordinator will get in touch via email or  phone to continue the process of enrolling your child at the Early Learning Center.
What town do you live in?
 *
At this time we are primarily enrolling children for Full-Time Enrollment. If you are interested in Part-Time Enrollment you may select the part-time option below and we will be in touch if a part-time slot becomes available. *
If we do not have a permanent opening are you interested in temporary spot?
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Please provide any additional information you would like us to know about your family's childcare needs in the box below:
If you have any specific questions you would like answered, please type them in the box below:
How did you hear about this enrollment inquiry form? *
A copy of your responses will be emailed to the address you provided.
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