We apologize, but the Current submittal of this form is not functioning properly.
As a work around for this issue, please copy the information and past it in an email to admin@eprcdc.com . Once we receive the information via email we can manually enter this into our database. You may also call 322-8310 to request a waiting list form to be sent to you in the mail.
Child's Name
Home Address
Date or Birth
Date Childcare Needed
Parent Name
Place of Employment
Home Phone
Cell Phone
Work Phone
Home Email
Work Email
I am a member of First Presbyterian Church, Birmingham Yes No
Current submittal of this form is not functioning properly. As a work around for this issue, please copy the above information and past it in an email to admin@eprcdc.com . Once we receive the information via email we can manually enter this into our database.
