CHILD'S NAME

BIRTH DATE

PARENT'S NAME

PHONE

ADDRESS

CITY & ZIP

TYPE OF CHILDCARE NEEDED FULLTIME (6AM-6PM) PRESCHOOL K2 PRESCHOOL K3 PRESCHOOL K4 PRESCHOOL K5

POTTY TRAINED YES NO

DATE CHILDCARE NEEDED

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Monday – Friday
6:00 am – 6:00 pm
205-853-7900

LifeChurch Learning Center

Daycare
5567 Chalkville Road
Birmingham, AL  35235

Director:  Candy Jeszka    candy@lifechurchal.com
Administrative Assistant:  Peggy Moore    peggy@lifechurchal.com