Please let us know your name.
City, State, ZIP
Please enter your phone number using the standard phone number format (XXX-XXX-XXXX).
Please let us know your email address.
Which Location(s) Are You Interested In?
Concordia on Seeley
Concordia on Whipple
Please select at least one location.
Which Program(s) Are You Interested In Receiving More Information On?
Infants (Concordia Day)
Toddlers / Twos (Concordia Day)
Toddlers / Twos (Whipple)
Part-time Twos (Seeley)
Twos / Threes (Whipple)
Part-Time Preschool (Seeley)
Part-Time Preschool (Whipple)
After School (Whipple)
Summer Camp (Whipple)
Please select at least one program.
What is your child's date of birth?
Please select a date.
If more than one child, please list additional dates of birth
Preferred start date for your child?
How did you learn about Concordia Place?
Internet / Social Media
Flyer / Postcard
If other, where did you hear about Concordia Place?
Additional Questions or Comments?
Please tell us how we can help you?
How can we reach you?