Please fill out the Child Care Request Form. All fields are required.
I acknowledge that by submission of this form my child will be added to the ECLC waiting list and that I will be contacted once space has become available following the waiting list if I am next on the list.
Typing my name below certifies that the information reported on this form is true and complete to the best of my knowledge. I also understand that if I purposely give false or misleading information, the request will be denied.