Inquiry Form

If you would like more information about our center, please fill out the form below. We will contact you with tour and availability information.

Inquiry

Please fill out the form below to receive additional information on the Children's Center of Brighton.

Parent/Guardian First and Last Name *

Parent/Guardian 2 First and Last Name

Email Address *

Phone Number *

(best number to reach you during the day)

Street Address

City

State

Zip

Child 1 Name *

Child 1 Date of Birth *

Child 2 Name

Child 2 Date of Birth

Child 3 Name

Child 3 Date of Birth

Please select Program of Interest * Childcare 6 weeks- 5 years old, Full DayKindergartenBefore and After School Program Please select Program of Interest

Enrollment/Days * Full Time: Monday - FridayPart Time: anything less than 5 days

Part Time Options * N/AMondayTuesdayWednesdayThursdayFridayFlexibleNot Flexible

Requested Start Date *

How did you hear about us?

Your Questions or Comments:

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