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	Parents Name:* Child's Name:* Child's Date of Birth: MELC Center you are interested in: Colonial School Based Programs (5-11 yrs) Families First Center (6 wks- 5 yrs) Infant Friendship Center (6 wks- 5 yrs) Jenkintown School Based Programs (5-11 yrs) Lower Merion School Based Programs (5-11 yrs) Narberth Center (6 wks- 5 yrs) Norristown Center (6 wks- 5 yrs) Pottstown Center (13 mos- 11 yrs) Kindergarten Jr. Day Camp - Lower Merion (5-11 yrs) Summer Camp - Plymouth Whitemarsh (5-11 yrs) Desired Enrollment Date: How did you hear about us? Phone: Email:* Address: City: State: Zipcode: