Register for Care

Tell us about your family, your child’s care needs, and the schedule you’re looking for. Iryna will follow up about availability and the next steps.

View weekly tuition Required licensing paperwork

Required information

Parent or guardian

Second guardian details are optional.

Parent or guardian name

Phone number

Email address

Preferred language

Street address

City

ZIP code

Second guardian name

Second guardian phone

Second guardian email

Child and care needs

Child’s full name

Child’s date of birth

Does your child have allergies?

Include food, medication, and environmental allergies.

Yes No

Allergy details and care instructions

Does your child take medication during care hours?

We’ll follow up about any medication authorization needed before care starts.

Yes No

Medication and instructions

Anything else that would help us care for your child?

Emergency contacts and authorized pickup

List a trusted adult we may contact if we cannot reach a parent or guardian.

Emergency contact name

Relationship to child

Emergency contact phone

May this person pick up your child?

Backup emergency contact name

Backup emergency contact phone

Other authorized pickup contacts

Child’s physician or clinic

Physician or clinic phone

Program and schedule

Care is available Monday through Friday, 8:00 a.m.–6:00 p.m.

Program

Preferred schedule

Preferred start date

Requested days and start dates are subject to availability and are not guaranteed.

Preferred weekdays

For part-time care, choose two to four days.

Permissions and acknowledgments

Photo and video permissions are optional and do not affect enrollment. Choose Yes or No for each.

May we share photos or videos of your child in private family updates?

This covers updates shared privately with enrolled families.

Yes No

May we use photos or videos of your child in public materials?

This covers our website, social media, and printed promotional materials.

Yes No

For questions, call 323-447-9477. Privacy Policy