Early Learning Center and Hoosier Hills Childcare Center - Interest Form: 2022-2023 School Year
Please fill out the following information to express your interest in enrolling in one of our childcare centers. Seats are limited; this registration does not guarantee enrollment. When a seat becomes available for your child, our Assistant Manager of Early Learning Programs will notify you of the available seat through email. You will have 48 hours to respond to the offer, and it will be rescinded if response is not received. Thank you for your understanding.
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Child's First Name *
Child's Last Name *
Child's Date of Birth *
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Sex
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Primary Contact: First and Last Name *
Primary Contact: Phone Number *
Primary Contact: Email Address *
Secondary Contact: First and Last Name
Secondary Contact: Phone Number
Secondary Contact: Email Address
Please indicate your preferred facility *
Please indicate your enrollment needs for the 2022-2023 school year. *
Preferred Start Date *
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