GAF Childcare Center Pre-Registration Form

Name

This field is for validation purposes and should be left unchanged.

Please fill out this pre-registration form to be considered for one of our infant or toddler full and part-time spaces. After this form is submitted, we will contact you to schedule an interview to meet your lovely family! We will discuss your childcare needs and our philosophy.

Parent #1 Name(Required)

First Last

Parent #2 Name

First Last

Child's Name(Required)

First Middle Last

Child's Birth Date(Required)

Child's Gender(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Primary Email(Required)

Secondary Email (Optional)

Preferred Start Date

Parent #1 Primary Phone

Parent #2 Primary Phone

Preferred Care Schedule(Required)

Exceptional Childcare Needs

Additional Comments

If not full-time, please indicate preferred schedule.