Little Explorers Early Learning

Enrollment form

Complete the form below to enroll your child in Little Explorers. A team member will confirm your enrollment and schedule within 1–2 business days.

Child info

Parent info

Program

Payment

Child information

First name *Required.

Last name *Required.

Date of birth *Required.

Sex *Required.

Allergies or medical conditions we should know about

Primary language at home

Does your child currently receive ABA services?

Yes — Beautiful MindsYes — another providerNo

Parent / guardian information

Full name *Required.

Relationship *Required.

Phone *Required.

Email *Valid email required.

Home address *Required.

Emergency contact name & phone (if different)

Program selection

Age group *Required.

Schedule type *Required.

Selected rate

Preferred start date

Additional notes or questions

Payment method

Choose your preferred payment method. Card payments are processed securely through Square. Cash and check are arranged with the Little Explorers team on your child's first day.

3.3% + $0.30 processing fee applies to card payments

Enrollment submitted!

Thank you! We have received your enrollment request. A team member will confirm your schedule within 1–2 business days. We can't wait to welcome your little explorer!

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