Home Useful Information Enrollment Interest Form

Enrollment Interest Form

We would love to take care of your child! Please fill out this form and we will get in touch with you shortly.

Parent/Guardian Name*
Prefix First Last Suffix
Please enter the name(s) of the Parent/Guardian of the child(ren) you want to enroll in the center.
Additional Parent/Guardian Name
Prefix First Last Suffix
Address
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Child 1 - Name*
Child 1 Birth Date*
Child 2 - Name
Child 2 Birth Date
Child 3 - Name
Child 3 Birth Date
Child 4 - Name
Child 4 Birth Date
Child 5 - Name
Child 5 Birth Date
Hours Needed*
- Day Shift
- Evening Shift
Location
- NDLA
- NDLA II
- NDLC
Payment Method*
- Out-of-Pocket Tuition
- Illinois Department of Human Services
Click HERE to check your IDHS eligibility.

NDLC