PA Day Care Request Program

Please select the dates that you require as well as the other fields.

For 3 or more participants from the same family, we ask that you complete this form again.

2020-21 Dates
Participant Information
Do Any of the Participants Require EA Support at School?
Parent / Guardian Information
Have You Completed the Participant Information Form Recently?

If no, please right click and open this link in a new tab:

Other Information