Contact Us

Address:
21 North Fifth Street
West Hazleton, PA 18202
Phone: 570-454-4238
Fax: 570-708-2099
Email: pixieparadiseccc@hotmail.com

Parent/Guardian Name *
Email Address
Contact Number *
Best time to Contact You *   6am to Noon
  Noon to 5pm
  After 5pm
Child #2 Name *
Child #1 Age *
Child #1 Potty Trained? *
Child #2 Name
Child #2 Age
Child #2 Potty Trained?
Child #3 Name
Child #3 Age
Child #3 Potty Trained

Payment Method *

  I pay privately for child care.
  I am currently participating in a subdy program for child care.
  I am on the waiting list to participate in a subsidy program for child care.

Subsidy Caseworker Name
Additional Notes: