Contact form

Guardian's First Name *

Guardian's Last Name *

Phone Number *

Phone Type *

Email Address *

Address

City

State

Zip Code *

Location *

How did you hear about Children's Lighthouse? *

What type of care do you currently have?

First Child's Information:

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's Desired Start Date *

Second Child's Information:

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Desired Start Date

Parent Information

Is there anything specific you are looking for in a childcare program?