Registration

* - Required Field

Select the location (The Children's Village or Jendza Early Learning) *

The Children’s Village, Inc Jendza Early Learning Center

Child's First Name*

Child's Last Name*

Birth Date*

Parent/Guardian 1’s Information
Name

Address 1

Address 2

City	State	Zip Code

Phone	Email

Employment

Employment Phone	Employment Email

Parent/Guardian 2’s Information
Name

Address 1 Address Same as Parent/Guardian 1’s

Address 2

City	State	Zip Code

Phone	Email

Employment

Employment Phone	Employment Email

Your Needs*

Do you want your child to have hot lunch?
Infant Toddler Preschool Pre K Kindergarten Nursery School (Mornings Only 9-12)
Hours

Days Needed
Monday Tuesday Wednesday Thursday Friday

After School Care

After School Information
After School Transportation
School	Hours

Days Needed
Monday Tuesday Wednesday Thursday Friday

Start Date*

We accept Master card and Visa debit or credit cards.