AFTER CARE — Irvington Extended Day Program

Fields marked with an * are required

Custodial Parent Name *

Relationship to Child *

Child's Name *

Date of Birth (Month, day, year) *

Street Address *

Zip Code *

Home Phone *

Estimated Entry Date

Grade Fall 2022 *

Your Email *

I have applied to ERDC https://oregonearlylearning.com/parents-families/child-care-assistance-family-support/

AFTER CARE — Irvington Extended Day Program Irvington Extended Day Program