Enrollment Inquiry

Let's Start the Conversation

Thank you for your interest in Genesis Steps to Success. Complete this short form and our team will contact you with the next steps.

Quick & Easy

Send Us an Inquiry

This is a first-contact form — not the full application. It only takes a minute.

No commitment — just tell us about your family
We respond within 1 business day
We'll walk you through availability & next steps

Already have a parent account? Complete the full application.

Prefer to talk? Call us at (978) 489-8401.

Parent / Guardian Information

Parent / Guardian Name *

Phone Number *

Email Address *

Preferred Contact Method

Child Information

Child 1

Child's Name *

Child's Age

Child's Date of Birth

Program Interest

Program Interested In *

Requested Start Date

Preferred Schedule

Additional Information

Any allergies, medical needs, or special care instructions?

Message / Questions

Acknowledgment

I understand this is an enrollment inquiry only and does not guarantee a spot. Genesis Steps to Success will contact me regarding availability, next steps, and full enrollment requirements.

I understand that only one enrollment inquiry per family is allowed each month. I may include all of my children on this single inquiry. To update my inquiry or add a child before then, I will call or reply to my confirmation email.

By signing below, you confirm you are this child's parent or legal guardian (or otherwise authorized to enroll them), and that you are at least 18 years old.

Parent / Guardian Signature *

Date *

We'll only use this to respond to you and, if you enroll, to care for your child. See our Privacy Policy for details.