Intake Application

The Enrollment Process 
The Intake Application is the first step to getting your child enrolled for services at Children Inc. Learning Center.  After you submit the intake application, you will be contacted to complete the rest of the enrollment packet. If there is an enrollment wait list for your child’s age, we will tell you at the time your are contacted.  If you don't want to fill out this form online you can download the application and fill it out by clicking here .

Admission Policy 
The center will accept children who are six weeks through age twelve (12)/ or sixth grade.  The center will admit and serve any child as long as the center is capable of meeting a child’s needs and the child is not a danger to other children in the center.  There will be no discrimination on the basis of race, color, religion, sex national origin, or disability.

Child's Info

Click or drag a file to this area to upload.

Mother's Info

Father's Info

Other info

By clicking on the Submit button you confirm that all the information entered is accurate and correct to the best of your knowledge.