Preschool/Head Start/Early Head Start Enrollment Application 2024-2025
Thank you for your interest in our Preschool/Head Start/Early Head Start program.  

To be considered for Preschool/Head Start Registration a child must be 3 or 4 years old on or before August 1, 2024.  Early Head Start services are for pregnant moms and infants and toddlers through 36 months of age on or before August 1, 2024.

If you would like to submit information for more than one child, complete a form for each child.  You must complete this entire form before exiting.  This form will take approximately 30 minutes to complete all sections.

Once you complete all portions, the application will be sent directly to our office and we will contact you to complete the in-person portion of the application and to bring in the required documentation (this is listed at the end of this application).
                                                                                                              
Again, thank you for your interest in our program.  If you have any questions, please call the preschool office at (270) 527-6757.
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Applicant's (child) Legal FIRST Name *
Applicant's (child) Legal LAST Name *
Preferred Name
Applicant's (child) Date of Birth *
MM
/
DD
/
YYYY
Applicant's (child) Gender *
Applicant's Race (choose all that apply) *
Required
Applicant's Ethnicity *Hispanic or Latino origin?  *A person of Cuban, Mexican, Puerto Rican, South/Central American or other Spanish Culture or other Spanish culture regardless of race. *
Applicant's Primary Lanuage *
Applicant's English Proficiency *
Parent/Guardian Names *
Living Address: Street Address *
Living Address: City *
Living Address: Zip Code *
County *
Mailing Address (ONLY if different from Living Address)
Mailing Address: City
Mailing Address: Zip Code
Family Phone Numbers:  H=Home  C=Cell  W=Work   M=Message *
Family E-mail:
I give permission to contact me via cell/text/e-mail regarding information on my child and school activities.  Choose all that apply *
Required
Directions to home
Preferred Method of Child Transportation to School:
Pick up location if different than home and directions to that location
Drop off location if different than home and directions to that location
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