Thank you for your interest!

Inquiry Form

Our center follows an inquiry process so that we can gather some information on your current childcare needs. After this form is completed you we will be in touch to give you more information on tours and enrollment process.

If you’re not ready to apply just yet, feel free to fill out this form and we will get back to you shortly!

1. Parent/Caregiver Information

Parent/Caregiver (1) First Name

Parent/Caregiver (1) LastName

Email (1)

Phone Number (1)

Address

Parent/Caregiver (2) Full Name

Parent/Caregiver (2) LastName

Email (2)

Phone Number (2)

Address

2. Enrollment Preferences

How many children are you inquiring about?

Date you plan to enroll by? (estimated date)

Date of birth (child/children) (1)

Date of birth (child/children) (2)

3. Child Development & Referral

Our center offers (2) different options with extended day available for an extra monthly rate. Check all that apply.

Schedule/Hours of Interest?

5 x days a week - 8 AM - 2:30 PM 4 x days a week - 8 AM - 2:30 PM Extended Day Add On - 2:30 PM - 4 PM Undecided

Please check all that apply in regards to your child: *

Walking with no supports Walking with assistance Crawling Feeding independently Feeding requires assistance

How did you hear about our center? *

Friend - Family Social Media Passing by Richmond Street Flea Referral Flyer

Other:

Ready to begin?

Plant the seeds of a lifelong learner

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Contact:

(267) 788-1589
3104 Richmond St, 1st Floor, Philadelphia, PA 19134
Director@evergreenelc.com
Mon – Fri 8AM – 4PM

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