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Early Learning Center Waiting List
Please fill out this form and we will contact you with more information!
Por favor complete este formulario y nos pondremos en contacto con usted con más información!
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* Indicates required question
Parent-Guardian/Padre-Guardian
*
Your answer
Phone number/Número de Teléfono
*
Your answer
Email address/Correo electrónico
Your answer
Child's name/ Nombre del niño(a)
*
Your answer
Date of Birth of child/ Fecha de Nacimiento del niño(a)
*
MM
/
DD
/
YYYY
Classroom /Salón de Clases
*
Infants: 6 weeks- 18 months
Toddlers: 18 months-3 years
Preschool: 3 years to 5 years
Other:
When do you need childcare?/¿Cuándo usted necesita el cuidado de niños?
*
Immediately /Inmediatamente
Fall/Otoño
Summer/Verano
Other:
Questions or comments:/ Preguntas or comentarios:
Your answer
How did you hear about Genesis?/¿Cómo usted se enteró de Génesis?
I am a Genesis student/Soy un estudiante de Genesis
Friend/Amigo(a)
Live in the neighborhood/Vive en el vecindario
Social Media/Website
Other:
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