Children's Learning Center Inquiry Form

Please complete the following form for all Children's Learning Center program inquiries. Availability is limited and based on our ability to accomodate the scheduling needs of new enrollments. Please understand that completion of this form DOES NOT ensure or guarantee placement in our program.

Today's Date*
Child's Legal Name*
First Name Middle Initial Last Name
Child's Date of Birth*
Child's Gender*
Parent/Guardian's Legal Name*
First Name Middle Initial Last Name
Email Address*
Phone Number*
Needed Days of Full-Day Programming (7:30am-5:30pm)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Needed Days of Half-Day Programming (7:30am-12:30pm)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Needed Days of Before School Programming (7:30am-8:20am)
Before school programming is available to accepted GRSP students.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Needed Days of After School Programming (3:15pm-5:30pm)
Before school programming is available to accepted GRSP students and school age siblings.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Desired Start Date for Programming*
Questionnaire
Is your child currently potty trained?*
Does your child require any special needs or accomodations?*
Has your child previously been in a preschool or child care setting? If so, where?*
Questions/Comments
Please provide any additional information that you would like us to know.
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Children’s Learning Center Inquiry Form

Children's Learning Center Inquiry Form

Questionnaire

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