Enrollment | PECS

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Enrollment Application

First Name

Email

Number of Children

What days will you need care? * Required

Monday

Tuesday

Wednesday

Thursday

Friday

Before and/or After Care

Last Name

Phone

Provide the child(ren)'s names and ages

Does your child(ren) have any allergies or special needs?

Is this the first time your child(ren) have been enrolled in a Home Day Care?

Type of Payment for Care

Thank you! We’ll be in touch.

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