Enrollment Inquiry
Please complete each line.  If we have space for your family, we will reach out to schedule a tour at the location of your choice!  
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Email *
Child Name *
Child Date of Birthday *
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Child Age *
Days of Needed *
Required
Pick up & drop off times                                          (example, M-Tu-W 8-3, Th-Friday 9-5)
Site Preference (more than 1 choice allowed) *
Required
Interested in School Age Before & After Care? *
If interested in Before/After at which school?
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Interested in what type of care? *
Parent first & last name *
Parent phone number: *
OK to text message? *
Email address *
Why are you interested in services? *
How long do you plan to use services? *
Payment type: *
Desired Start Date? (Phoenix cannot hold unpaid slots for more than 1 week) *
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How did you hear about Phoenix?  Anything you would like us to know? *
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