Children and Youth Development and Education Inquiry Form

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Children and Youth Development and Education

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Inquiry Form

* I am interested in:

* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
E-mail Address:
Home Phone:
Work Phone:
Cell Phone:
* Phone Preference:

* 1st Child's Name:
* Date of Birth:
Special Needs:
2nd Child's Name:
Date of Birth:
Special Needs:
3rd Child's Name
Date of Birth:
Special Needs:
Please add me to the Children and Youth Development and Education Center waiting list.	Yes No
* Payment Type:

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The YWCA Children and Youth Development and Education Center, located in Homewood-Brushton, provides quality, comprehensive early development and education and out-of-school time programming for children six weeks to twelve years of age. Our commitment is to:

Provide a safe environment for all children
Encourage social and emotional development
Promote physical growth and development
Stimulate intellectual growth and development
Follow developmentally appropriate practices

Licensed by:
PA Department of Public Welfare

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