Healthy Child Care Pennsylvania : Request for ECELS Materials


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ECELS -
Healthy Child Care PA

Rose Tree Corporate Center II, Suite 3007
1400 N Providence Rd
Media, PA 19063

PA Only: 800-24-ECELS
Phone: 484-446-3003
Fax: 484-446-3255

E-mail: ecels@paaap.org

Upon completion and submission of this form, your request for ECELS materials will be
e-mailed to ECELS-Healthy Child Care Pennsylvania. Fields in red are required.

Please note: Free materials provided to PA health and early education and child care professionals only.

Name:
Title:
Child Care Program or Agency:
DPW Facility ID# (if applicable)
If a consultant, check here:
Address 1:
Address 2:
City:
State:	PA
Zip:
Phone:	Must be in 123-456-7890 format.
E-mail:	A copy of this request will be e-mailed to the address provided.
Video Format (select one):
Publication :	Pennsylvania Immunization Card