Please complete the enrollment form below and we will get back to you as soon as possible. 

Name of person(s) PROHIBITED from picking up your child (if applicable)

Health Statement:

As the parent/guardian of the above referenced child, I certify he/she/they are in good physical health and may participate in the normal activities of the program and has no ciditions or specific needs that require specific accomodations, unless otherwise notated in the medical information provided above or a disclosed Universal Health Record of a Care Plan for Children with Special health Needs.

Emergency Treatment:

As the parent(s)/legal guardian(s) of the above named child, I (we) attest that the information above is correct. I (we) authorize the child care center staff to obtain emergency treatment for my child and understand that I (we) shall promptly be notified.

Permissions:

Enrollment Submission:

By clicking the Submit button below, I (we) attest that all information provided on this enrollement application is accurate.