Register Your Child

[contact-form to=”brad@bradwebdesign.com,karen-lindsay@hotmail.com” subject=”Child Registration for East Coast Kids”][contact-field label=”Name” type=”name” required=”1″][contact-field label=”Email” type=”email” required=”1″][contact-field label=”Phone #” type=”text”][contact-field label=”Child’s Name” type=”text”][contact-field label=”Child’s Age” type=”text”][contact-field label=”Part Time or Full Time” type=”select” options=”Full Time,Part Time”][contact-field label=”Days Attending” type=”checkbox-multiple” options=”Monday,Tuesday,Wednesday,Thursday,Friday”][contact-field label=”Start Date” type=”text”][contact-field label=”Which Location?” type=”select” options=”Hillsborough,Riverside-Albert”][contact-field label=”Will you be applying for daycare assistance?” type=”select” options=”Yes,No,Would like some more information”][contact-field label=”Message” type=”textarea”][/contact-form]