Program waiting list- under 2 years old

If you would like to join our waiting list and can answer "yes" to the following three questions, please complete the form, thanks!

1. Do you live in Georgetown County?

2. Can you or a caregiver commit to 2 thirty-minute visits twice weekly?

3. Do you want to become your child's first, best teacher and school advocate?

Please continue.

Your Contact Information

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Parent or Caregiver Full Name * The field Parent or Caregiver Full Name is required.

Your home address The maximum length for the field Your home address is 500 characters.

Your email address The maximum length for the field Your email address is 500 characters.

Your mailing address if different than above The maximum length for the field Your mailing address if different than above is 500 characters.

How do you prefer we contact you, call or email? The maximum length for the field How do you prefer we contact you, call or email? is 500 characters.

How did you hear about us? The maximum length for the field How did you hear about us? is 500 characters.

Child's full name The maximum length for the field Child's full name is 500 characters.

Child's date of birth The maximum length for the field Child's date of birth is 500 characters.

How did you hear about us? The maximum length for the field How did you hear about us? is 500 characters.