Jenkins ECLC Registration - New Families
PLEASE FILL OUT THIS FORM SEPARATELY FOR EACH OF YOUR CHILDREN. Thanks!

Registration fees will not be charged until we confirm your spot.

Questions? Contact Gina Benson at bensong@dexterschools.org or call 734-424-4180 ext. 1413.

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Email *
Your Name *
Your Role *
Your Phone Number *
Second Parent or Guardian Name (type N/A if none) *
Second Parent/Guardian Email
Second Parent/Guardian Phone
Home address *
Student Full Name *
Student Birthdate *
MM
/
DD
/
YYYY
Has this student previously attended care?
Clear selection
Is this child fully potty trained? *
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