Enrollment Form

Join our waiting list and be among the first families to experience quality childcare at Mercy Education Learning Center.

Coming Soon - Join Our Waitlist!

Priority Access

Waitlist members get first priority when we open our doors

No Commitment

Join our waitlist with no obligation or fees required

Stay Informed

Receive updates on our opening timeline and enrollment process

Enrollment Application

Please fill out this form completely to join our waitlist. All fields marked with * are required.

Child Information

Child's First Name *

Child's Last Name *

Date of Birth *

Current Age *

Program Interest *

Preferred Start Date

Preferred Schedule

Parent/Guardian Information

First Name *

Last Name *

Relationship to Child *

Email Address *

Phone Number *

Address *

City *

State *

ZIP Code *

Emergency Contact

Full Name *

Phone Number *

Relationship *

Additional Information

Special Needs or Accommodations

Allergies or Dietary Restrictions

Current Medications

Additional Comments

Agreements

I agree to the terms and conditions of enrollment and understand that this application places my child on the waitlist with no guarantee of enrollment. I will be contacted when enrollment becomes available. *

I give permission for my child to be photographed for educational documentation and center promotional materials (optional).

By submitting this form, you agree to join our waitlist and receive updates about enrollment opportunities.