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Personal Information
Fullname
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Child Name
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Email
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Phone Number
Services
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School Age/Summer Camp
Infants 6 weeks to 12 months
Infant full time Ages 6 week to 12 months
Toddlers 13 months to 36 months (not potty trained)
Potty trained toddlers
Toddler full time 13 months to 18 months
Preschoolers 3 years to 5 years (potty trained)
Preschool full time Completely potty train
Child Care Assistance co-pay
A week Drop-In Care
A day up to 8 hours Drop-In Care for Full-time Students
Registration (Children Place)
Registration (Shirley Honore's)
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Center Name
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Shirley Honore's Love Center Learning Academy LLC(Bayou Rd)
Children's Place Love Center Learning Academy LLC (Bienville St.)
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Amount
$
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Additional Information (optional)
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Card Number
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Name on Card
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Expiry Date
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Security Code
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