Inquiry Form

If you are human, leave this field blank.

Your name *

Email address *

Phone Number *

Street Address *

Town *

State *

Zipcode *

What are your children's names and dates of birth or due date? *MM/DD/YY

How soon are you looking to make a decision about care? *

Within a month

Within 2-3 Months

Longer than 4 months

What is your preferred start date? *

We provide mixed-age grouping at Applewood. Which mixed-age classroom are you interested in? *

Mixed-age Infants & Toddlers for children ages 6 weeks to 3 years

Mixed-age Preschool for children ages 3 years through 5 years

Kindergarten Enrichment (within Preschool) 11:30-6pm only

What days of the week do you need care? Minimum enrollment is 3 half days or 2 extended days per week. *

What is your preferred schedule? *

Half Day - hours are 8:30am-12:30pm (minimum of 3 days)

Extended Day - hours are 8:30am-2:30pm (minimum of 2 days)

Full Day 6:30am-6:00pm (minimum of 2 days)

Kindergarten Enrichment - hours are 11:30am-6:00pm (minimum of 2 days)

Please tell us a little bit about your child and family. *

Please tell us about your and your child's current or previous experiences in a child care setting. *

Did you hear about us at DerryFest? *

Yes

If no, how did you hear about us?