Infant & Toddler Interest Form

Infant & Toddler Interest Form

Early Learning Centers - North and South
Please fill out the following information to express your interest in enrolling your infant or toddler at one of our Early Learning Center locations.

Seats are limited, and completing this form does not guarantee enrollment.

When a seat is available, you will be notified via email on the next steps of enrollment, including a tour of the child care center. You will have 48 hours to respond to the offer, and it will be rescinded if response is not received.

The Early Learning Centers provide full-time care for children ages 6 weeks through 3-years-old.

If you have any questions, please contact the Office of Early Learning and Out of School Programs:

Child's Name:*

First NameLast Name
Child's Date of Birth:*

MonthDayYear
Date
Gender:*

MaleFemalePrefer not to answer
Child's Primary Residence:*

Street Address

Street Address Line 2

CityState

Zip Code
Preferred Location:*

Early Learning Center - North (HHCC)Early Learning Center - SouthNo Preference - First Available