Enroll | Gainesville Empowerment Zone

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352-225-3931

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Use this form to indicate your interest in enrolling your child at the GEZFLC.

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First Name

Last Name

Email

Phone

Childs Date of Birth

Preferred Start Date

Gender

Male

Female

Potty Trained?

Yes

No

Allegeries or Medical Condition

Medications

Special Needs or Accomodations requested

How Did you Hear about us?

Word of Mouth

Social Media

Wesbite

Drive by

Referral

Referral Name

Program(s) Interested in

Infant Care

Toddler Program

Preschool (3-5 years old)

Private VPK

VPK

Summer Program

After Care

Parent/ Guardian Name

Relationship to Child

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

Email

Name Additional Guardian/ Parent (optional)

Relationship to Child

Phone

Email

I accept terms & conditions

Thanks for submitting! We will get back to you shortly!

Gainesville Empowerment Zone

Family Learning Center

1250 NE 18th Ave BLDG.# 11,
Gainesville, FL 32609

352-225-3931

gnv4all@gnv4all.org

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