Little Govs Child Learning Center

Instructions: Please fill out each section and submit your application. You will be automatically added to the waiting list and contacted as soon as there is a slot available. * Please note, the average wait is 1-2 semesters, slots are filled in the order they are received. Thank you for your interest in our learning center.

Today's date:*

Contact Person

First name*

Last name*

Child Information

Child's First Name: *

Child's Last Name*

Birth date:*

Age Group at prospective time of enrollment:*

2 years old

3 years old

4 years old

When do you wish to start care?

Attendance Preference: *

Monday-Friday

Monday/Wednesday/Friday

Tuesday/Thursday

Primary e-mail address: *

Secondary e-mail address:

Primary Phone:Format: (xxx) xxx-xxxx

Secondary Phone:*Format: (xxx) xxx-xxxx

Affiliation:*

Student

Staff

Faculty

Alumni

Community

Little Govs Child Learning Center Waiting List

Contact Person

Child Information

Contact us!