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Children Learning Together

Little Learners Enrollment Request

Find the Right Care for Your Child

We’re excited to learn more about your childcare needs! Complete the form below, and a member of the Little Learners team will review your request and contact you regarding availability and next steps.

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Please note: Submitting this form does not guarantee enrollment or a childcare space. Enrollment is based on current availability. A member of the Little Learners team will contact you to confirm availability and discuss the next steps.

CHILD'S PRE-ADMISSION RECORD

Person's to be contacted in an emergency if parent(s)/guardian(s) cannot be reached.

Emergency Authorization:
Person(s) the child may be released to:
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
I give permission for my child to participate in:
Activities away from the facility
Yes
No
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Transportation provided by the facility
Yes
No
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Swimming/wading activities provided by the facility
Yes
No
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
This section is to be completed by the facility:
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