Childcare

Request for Information Form

If you are interested in receiving more information about Wesleyan Christian Childcare, please take a few moments to complete the following form.

I look forward to speaking with you soon and scheduling a tour of our facility.

Thank you for your interest,

April Glover,
Childcare Director

Section

Person Initiating Request*

Contact Email*

FIRST CHILD: Full Name, Gender*

Date of Birth*

SECOND CHILD: Full Name, Gender

Date of Birth

THIRD CHILD: Full Name, Gender

Date of Birth

Possible Enrollment Date*

Complete Address: Street, City, State, Zip Code*

Phone Number*

How did you hear about our childcare?*

Current childcare provider (N/A if not applicable)*

Name of home church:*

Use this area for comments or concerns: