Enroll Your Child

Are you interested in learning more about the programs Child Development, Inc. offers? Please complete and submit the form below and we’ll contact you. (NOTE: All areas of the form must be filled in.)

If you are not contacted within 3 business days, please call 570-544-8959, Ext. 223

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Parent Name

Phone Number

Parent Date of Birth

Street Address

City

State

Zip

Childs First Name

Childs Last Name

Childs Date of Birth

Child's Gender

Center