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Contact Us About Child Care

Name(Required)

First Last

Relationship to child/children(Required)

Email(Required)

Phone(Required)

I am interested in (check all that apply):(Required)

Infant Care (6 weeks – 18 months)

Toddler Care (18 months – 3 years)

Preschool (3 years – 5 years)

Early Head Start Program

Ohio Department of Education Preschool Program

I am interested in the following location:(Required)

East Center

North Center

Southeast Center

West Center

Not Sure

EAST CENTER
5831 Westbourne Ave.
Columbus, Ohio 43213

NORTH CENTER
1601 Shanley Dr.
Columbus, Ohio 43224

SOUTHEAST CENTER
2525 Petzinger Rd.
Columbus, Ohio 43209

WEST CENTER
485 Industrial Mile Rd.
Columbus, Ohio 43228

I qualify for PFCC(Required)

Publicly Funded Child Care Assistance (PFCC) - If you are working or going to school, you can apply for PFCC, which is help with paying childcare through the county department of jobs and family services. It is based on your income, family size, and hours worked or going to school. You may be required to pay a parent copayment.

Number of Children Interested in Enrolling?(Required)

Child 1 Information

Child's Name(Required)

First Last

Childs Birth Date(Required)

MM slash DD slash YYYY

Child 2 Information

Child's Name(Required)

First Last

Childs Birth Date(Required)

MM slash DD slash YYYY

Child 3 Information

Child's Name(Required)

First Last

Childs Birth Date(Required)

MM slash DD slash YYYY

Child 4 Information

Child's Name(Required)

First Last

Childs Birth Date(Required)

MM slash DD slash YYYY

Child 5 Information

Child's Name(Required)

First Last

Childs Birth Date(Required)

MM slash DD slash YYYY

Questions or Comments

Comments

This field is for validation purposes and should be left unchanged.