Enrollment Application

If you would like to fill out the form, print it and return it to us please click on the link: Child Care Application Form.pdf

Student Information

Primary Hours of Care:

Days of Week in Care:

Meals Typically Served While in Care:

Family Information:


Medical Information:

By filling out this section I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.


Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident, or emergency, if for some reason the custodial parent or legal guardian cannot be reached:

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