Childcare

Are you interested in applying for childcare and Hilltop’s
Early Childhood Education program?

This form is to express your interest in knowing more.  This form does not guarantee enrollment in Hilltop Neighborhood House childcare and early education. 

Your Name:
Street Address:
City, State, Zip:
Email Address:
Phone Number:
Where are you employed or attending school?:

Child Information #1

Name Of Child:
Date Of Birth:
Current School:
Classroom/Grade:

Child Information #2

Name Of Child:
Date Of Birth:
Current School:
Classroom/Grade:

Child Information #3

Name Of Child:
Date Of Birth:
Current School:
Classroom/Grade:

Working together, we thrive! How will you support Hilltop?