2023-24 Early Learning Center Application Form

Please complete this form to apply for a spot in EMU's Early Learning Center for the 2023-24 school year (September 2023 - May 2024). Applying does not guarantee a space. You will be contacted in early 2023 about the status of your application.

Child's Name Child's Name First Last
Child's Birth Date Child's Birth Date / MM / DD YYYY
Child's Current Age
Child's gender
Is this child currently enrolled?
Class you are applying for

Class you are applying for 2 day (Monday & Tuesday, 2 year olds) 2 day (Thursday & Friday, 2 year olds) 3 day (3 year olds) 4 day (4 year olds)
Parent's Name(s) Parent's Name(s) First Last
First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email address
Primary Phone Primary Phone - ### - ### ####
Alternate Phone Alternate Phone - ### - ### ####
Phone Number to be used for Text Alerts Phone Number to be used for Text Alerts - ### - ### ####

If you do not have a phone number that can receive texts, please type zeros here.
Are you an Eastern Mennonite University employee or student?
How did you hear about the Early Learning Center?