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Messiah College
Early Learning Center
Extended Care Waiting List Form

Monday-Friday
7:30 am - 5:30 pm
(717) 796-5043
(717) 691-6085


Please complete this online form, which will be sent to the Messiah College Early Learning Center. We will contact you upon receipt of your application.

The Early Learning Center makes every effort to provide care for Messiah College employees. Upon submission of this form, you will be placed on a waiting list for child care. Once the center confirms that our availability matches your child care needs, you may secure the space with a non-refundable registration fee of $50.00 no more than thirty days prior to desired start date.


Thank you for your interest in The Early Learning Center!


Child's Name: Date of Birth:
    Gender: Male Female
Mother's Name: Business Phone:
    Mobile Phone:
Father's Name: Business Phone:
    Mobile Phone:
Street Address: Home Phone:
City: Email Address:
State:    
Zip:    



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