Enrollment Form

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Your Name (parent/guardian full name)

Your Child's Name (optional)

Your Child's Age or Date of Birth

Phone Number

Email *

Zip Code / City

Preferred Contact Method?

Do you receive childcare subsidy (Working Connections/DSHS)?

Schedule You’re Looking For

Preferred hear (Working

Days needed

Start Date

How did you hear about us?

Any Questions or Notes?

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