Thank you for your interest in Explorika - Early Learning School & Child Care. We look forward to learning more about you and your family.

* Required Item

Parent Information

First Name *

Last Name *

Your Email (required)

How did you hear about Explorika *

Your Relationship with the child *
Father Mother Guardian 


Preferred Phone *

Mailing Address *

Area Name *

City *

Child Information

First Name *

Last Name *

Date of Birth *

Gender *
Male Female 


Seeking admission for *

Year Applying fo *

Does your child have any Special Educational Needs? *
Yes No 


Preferred day for campus visit *

Preferred time for campus visit *

Relationship Manager in contact with *


Company (Select only if Tie-up with Explorika exists) *

Additional Comments *

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