colorful clip art picture of three children running on top of books

Stepping Stones

Pre School • Day Care • Summer Program

Request Care Form

Request for Care Form

Thank you for your interest in Stepping Stones!

Please complete the form below and submit. Someone will contact you via email once we have received your form.

Parent Contact Information

Parent One

Please enter first name.
Please enter last name.
Please enter valid phone number. Ex: 123-123-1234.
Please enter valid email address.

Relationship to child?*

Please identify your relationship to child.

Parent Two

Please enter valid first name.
Please enter valid last name.
Please enter valid phone number. Ex: 123-123-1234.
Please enter valid email address.

Relationship to child?

Child's Information
Please enter valid first name.
Please enter valid last name.
Please enter child's age.
Please enter child's date of birth in mm/dd/yyyy format.

Is your child potty trained?*

Please identify whether or not your child is potty trained.
Program Information

Which program are you interested in?*

Please select the program you are interested in.

What days does your child need care?
Select all that apply*:

Please select the days of the week you are requesting care for your child.
Please enter your start date in mm/dd/yyyy format.

Tours are offered Monday-Thursday, 9am-11am.