Infant Toddler Enrollment Form

Phone 814-670-0838

Thank you for your interest in enrolling your child with Child Development Centers, Inc.

This new center will be opening in mid-June at 121 East 10th Street in Erie.
Please fill out the information below and an enrollment specialist will follow up as it gets closer to June.

Child's Name

First Name *

Last Name *

Birth Date

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County (Required)

County

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Primary Contact Name

First Name *

Last Name *

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Relationship to Child (Required)

Phone (Required)

Email (Required)

Email

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Number in Household (Required)

Number of People Living in the Household

Total Yearly Income (Required)

Gross Annual Income

How did you hear about us? (Required)

How did you hear about us?

If referred, please list the name of the person that referred you.

Thank you for your interest in enrolling your child with Child Development Centers, Inc.