TLC Child Care

The Learning Circle YMCA

In order to provide you with the most accurate information, please complete the following details.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Parent/Guardian's Name*

First NameLast Name
Phone*
Format: 000-000-0000.
E-mail*
- Which program are you interested in?*
  
  Infant/Waddler (6 weeks - 18 months)Toddler (18 months - 3 years)Preschool (3 - 4 years)Pre-Kindergarten (4 years)Kindergarten (5+ years)Other
- When do you plan for your child to begin attending this program?*
  
  MonthDayYear
  Date
- Are you a current member of the Y:*
  
  Summit YMCABerkeley Heights YMCANoOther
- Do you have any specific questions or comments:
- Do you have other children that you might be interested in enrolling? Please list their name(s) & age(s).
  Ex. Sara, 4 years
- A personalized tour can be arranged for you to walk-through our Child Care Center, see our programs and teachers in action, and speak in-depth with one of our experienced Program Directors. Please note: Tours are generally available Monday - Friday between 10:00 AM - 11:30 AM.
- Would you like to schedule a tour of the program?
  
  YesNo
- Are you interested in learning about Financial Assistance?
  
  YesNo
- How did you hear about us?*
  
  Referred by a FriendMy other child was a former studentWord of MouthYMCA CommunicationsGoogle SearchFacebookDrive byOther
- Please verify that you are human*
- Should be Empty:

The Learning Circle YMCA