Brightside Academy

Philadelphia • Pittsburgh

Where do you live? *

Philadelphia

Pittsburgh

Other

What is your relationship to the child? *

Parent

Grandparent

Legal guardian

Sibling

Aunt

Uncle

Other

Do you currently participate in Child Care Works (CCW) or ELRC? *

Yes

No

Not Sure

CCW stands for Child Care Works, Pennsylvania’s child care subsidy program.ELRC stands for Early Learning Resource Center

Which programs are you interested in? *

Child Care / Day Care

Preschool

Before/After Care

Summer Camp

Early Head Start

Head Start

PHLpreK

Pre-K Counts

Select all that apply.

What is your primary language? *

English

Spanish

French

How many children are you looking to enroll? *

1

2

3

4+

What is your Zip code? (this helps us know that we are reaching people in our area) *

What is your Full Name? *

What is your best phone number? *

What is your best email address? *

I agree to the terms & conditions provided by Brightside Academy, and by providing my phone number, I agree to receive text messages from Brightside Academy.

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