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.

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 Preadmission Record

This section is to be completed by the child's parent or guardian. This form must be kept in the child's file in the Child Care Facility (home/center).

Child’s Full Name

Child’s Date of Birth required

Name(s) of parent(s)/guardian(s)

Name Child is known by

Child's home address

Home Telephone Number

Address of Parent(s)/guardian(s)

Mother's Employer

Mother's Email Address

Father's Employer

Father's Email Address

Employer's Address

Employer's Telephone Number

List telephone numbers such as pager, cellular phone, etc.

Employer's Address

Employer's Telephone Number

Instructions regarding how parent/guardian may be reached in an emergency:

Desired Start Date required

Thanks for submitting!