Family Center Sign-up Form

Family Center Sign-up Form

February 2022
If you will be bringing your children to the LifeWise StL Family Center for childcare, please fill out this sign-up form for the dates you will be using the center. Due to the ongoing pandemic, spaces are limited. If you have any questions or concerns, please contact Shaurice Irons.

Main Line: (314)421-0400

Direct Line: (314)260-6386
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
How many children will you be bringing to the Family Center?
Is this your first time using the Family Center at LifeWise StL in 2022?

Yes (You will be directed to the registration form upon submission) No
Please list the children's names: