YMCA of Greater Erie

Infant Toddler Contracted Slots and Child Care Works Verification of Enrollment

"*" indicates required fields

The Infant Toddler Contracted Slots (ITCS) Program builds upon the already established infrastructure of the Pennsylvania Pre-K Counts (PA PKC) Program model. PA PKC has been in existence since 2007 and provides high quality pre-kindergarten services to eligible children. Building an infant toddler focused program with established PA PKC programs will allow continued focus on quality programming while building strongwomen transitions from infant-toddler to pre-kindergarten classrooms.

Infant Toddler Contracted Slots Program Information

Program Name*

Downtown YMCA

Early Learning Center

Early Learning University

Eastside Family YMCA

Parent/Child Information

Parent Name*

First Last

Child Name*

First Last

Child's DOB*

Parent Address*

Street Address Address Line 2 City State Zip

Infant Toddler Contracted Slots and Child Care Works Information Release

The Parent:

Authorizes and requests the ITCS program disclose to the ELRC, all information contained in this form to verify my child's enrollment in ITCS and the Child Care Works Program.

Signature*

Early Learning Resource Center:

Region 1
3823 West 12th. St., Erie, PA 16505

814-836-5898 or 800-860-2281
Fax: 814-314-2831