Enrollment Form

  • Child Information

  • Emergency Contact

    List individuals to notify, in case of emergency, when the parent or guardian cannot be reached. List in order of preference:
  • Immunization Record

    Parent/guardian must provide a copy of the current updated immunization record to the child care program. Refer to Appendix II, Immunizations, in Requirements for Child Care Programs for immunization and exemption procedures.
  • Browse Files
  • Health Record

  • Transportation

  • Pick Up Permission

    Individuals who have permission to pick up my child:
  • Signature

  • Clear
  • Childcare Program Use

  • Financial Aid

    We strive to make the enrollment process as convenient as possible for you. That's why we gladly accept multiple forms of payment

  • Total $0.00
  • Please click one of the PayPal options to complete payment and submit the form.

  • Should be Empty: