Porter-Leath Preschool Recruitment Questionnaire
Complete the following questionnaire to start the process for the Preschool application. Please only complete one form per child.  

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Email *
Primary Parent Name *
Primary Phone Number *
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Zip Code *
Best Time of Day to be Contacted *
Required
Is either parent currently employed by Porter-Leath? *
Do you currently receive DHS Childcare Certificates? *
Please indicate your center of interest: *
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