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Enrollment Application

Child's Name
Date of Birth
Gender
   
Add another child
Home Address
City
State
Zip
Home Phone
Mother's Name
Cell Phone
Email Address
Employer
Daytime Phone
Father's Name
Cell Phone
Email Address
Employer
Daytime Phone
Enrollment Date
Desired Programs (Check all that apply)
School Attending
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This application for enrollment does not guarantee enrollment. Please call the center to check the availability of the program for your child/children. Most locations require a non-refundable registration fee in order to secure a child's spot and/or be placed on a waiting list. The information given in this document should be correct to the best of your knowledge. Please contact the center location directly with any questions.
Name
Email Address
Phone Number
Message
Schedule a Tour
Schedule your in-person tour here to visit Children's Lighthouse Raleigh.
Name
Cell Phone
Email Address
Children's Ages
6 Weeks - 24 Months
2 - 5 Years
Kindergarten - 12 Years
Date
Tomorrow
Time
7:30AM