Lillio formerly HiMama
Submit a request for childcare at E & C Early Learning Center

Fill out this application form to request a spot for your child at E & C Early Learning Center .


Child information
First name
Last name
Date of birth
Gender(optional)
Select gender

Child's primary address
Street address
Address line 2(optional)
City
State / province
Country
Select
ZIP / postal code(optional)

Parent or guardian
First name
Last name
Relationship to child
Select
Email
Retype email
Phone number(optional)

Emergency contacts

Records

Enrollment information
Preferred start date
Preferred time of day(optional)
Preferred weekly schedule

 (optional)

Subsidy(optional)
Additional notes

 (optional)

Please provide details to assist with selection (ie. part-time/full-time care, preferred schedule, subsidy needs, siblings attending the center etc.)

Max 400 characters