Enroll

Please submit this form in order to be contacted by a Carelot Staff member to complete the enrollment process. Receipt of this form alone does not confirm enrollment in our programs.

Preferred Center*:
Child Name*:
Child DOB*:
Address:
Email:
Home Phone:
Guardian 1:
Name*:
Work Phone:		Cell Phone:
Guardian 2:
Name:
Work Phone:		Cell Phone:
Days of Week*:	Monday Tuesday Wednesday Thursday Friday
Arrival Time:
Departure Time:
Begin Date: