Contact Information & Current Openings

Parent/Guardian Information

Last Name First Name

Street Address

City State Zipcode

Email Address

Day Phone

Evening Phone

Best Time to Call

Were you referred by a parent who has or formerly had a child in our care?

If yes, please enter parent’s name

Child Information
Please fill out the following fields for the child or children you wish to enroll.

Child #1
Last Name First Name

Date of Birth Gender

Child #2
Last Name First Name

Date of Birth Gender

Child #3
Last Name First Name

Date of Birth Gender

Date you would like your child/children to begin

Preferred Schedule

Please select the schedule that will best fit your needs

If you selected Other, please specify your preferred schedule

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Contact Information We are located in West Portage, Michigan in the Amberly Elementary School area. Our hours are Monday – Friday 7:30 a.m. – 5:30 p.m. We enroll children between the ages of 16 months – 5 years. Older children are welcome to attend if we have an opening. You can request additional information by sending an e-mail to info@athomechildcare.com, or you may complete and submit the form below and we will contact you as soon as possible. Parent/Guardian Information Last Name First Name Street Address City State Zipcode Email Address Day Phone Evening Phone Best Time to Call Were you referred by a parent who has or formerly had a child in our care? If yes, please enter parent’s name Child Information Please fill out the following fields for the child or children you wish to enroll. Child #1 Last Name First Name Date of Birth Gender Child #2 Last Name First Name Date of Birth Gender Child #3 Last Name First Name Date of Birth Gender Date you would like your child/children to begin Preferred Schedule Please select the schedule that will best fit your needs If you selected Other, please specify your preferred schedule