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Midland Evangelical

Free Church

Sunday Worship 9:00 & 10:45 AM

The Portal

Firm Foundations Interest Form

Welcome to Firm Foundations, we are excited that you are interested in our Early Learning Center! Please fill out the below information for your family. We look forward to connecting with you soon!


HEAD OF HOUSEHOLD #1
Parent/Guardian

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Relationship to Child:
*Prefix:
Marital Status:
*Birthdate:
*How did you hear about Firm Foundations:
If Applicable from above, who connected you with Firm Foundations?:

HEAD OF HOUSEHOLD #2

If there is not a 2nd adult Head of Household, please skip this section and go to the Household Member #3 section.
Are Head of Household 1 and Head of Household 2 married to each other?:
Relationship to Child:
* Prefix:
* First Name:
* Last Name:
Email:
Cell Phone:
Marital Status:
* Birthdate:

CHILD # 1

* First Name:
* Last Name:
* Gender:
* Birthdate:
* Age Group:
* Full-time or Part-Time?:
SCHEDULE
Indicate the time the child will need care for each day. If day is not needed, indicate n/a. Maximum hours are 7:00am-6:00pm
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

CHILD # 2

If there is not 2nd child please skip the following sections and submit the form at the bottom of the page.
* First Name:
* Last Name:
* Gender:
* Birthdate:
Age Group:
Full-time or Part-Time?:
SCHEDULE
Indicate the time the child will need care for each day. If day is not needed, indicate n/a. Maximum hours are 7:00am-6:00pm
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

CHILD # 3

If there is not a 3rd child please skip the following sections and submit the form at the bottom of the page.
* First Name:
* Last Name:
* Gender:
* Birthdate:
Age Group:
Full-time or Part-Time?:
SCHEDULE
Indicate the time the child will need care for each day. If day is not needed, indicate n/a. Maximum hours are 7:00am-6:00pm
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

CHILD # 4

If there is not a 4th child please skip the following sections and submit the form at the bottom of the page.
* First Name:
* Last Name:
* Gender:
* Birthdate:
Age Group:
Full-time or Part-Time?:
SCHEDULE
Indicate the time the child will need care for each day. If day is not needed, indicate n/a. Maximum hours are 7:00am-6:00pm
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
You will be contacted within 48 hours of submitting this form online. The Director, Renee Johnson, will connect with you regarding the program, your desired schedule and available space at the Early Learning Center.