Child Care Request Inquiry Coulee Children's Center

Coulee Children's Center - Where Your Child is the Center

Child Care Request Inquiry

If you would like to inquire about child care availability for your child/children, please fill out inquiry form below. A staff member will reply to you via email shortly. Your inquiry does not obligate you in any way to register.

Please note:

Full time children have priority over part time children.
Siblings of children already attending the program have top priority.

Please contact me regarding child care availability:

Your Name:

Email: Phone:

Address (Street, City, Zip):

Child's Name: Age:

Birth Date:

Present child care Arrangement:

How soon is care needed:

Child's Schedule (e.g. 7:45-3:45):
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

Questions/Comments:

How did you hear about our center?

Phone Book/Yellow Page (CenturyTel)

Phone Book/Yellow Page (Verizon)

Family Resource Center

Family/Friend/Co-worker

EIP/Birth-to-Three Program

Other (please specify)

About Us \| Our Philosophy \| Programs \| For Parents \| Staff \| News & Events \| Fundraising \| Contact Us \| Site Map 2935 East Ave. South \| La Crosse, WI \| 54601 \| 608.787.5572 \| fax: 608.787.7775
Last Updated: 06/25/2008 Comments To: webmaster1 at couleechildrenscenter.com	© Coulee Children's Center, 2002-2008 DHTML Menu courtesy of Milonic.