Enrollment Application 2025-2026
Thank you for your interest in our Preschool/Head Start or 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, 2025.  Early Head Start services are for infant and toddlers through 36 months of age on or before August 1, 2025. If you would like to submit information for more than one child, complete a form for each child. Please complete the information listed below and a staff member will contact you within two weeks.  When filling out this application, you will be asked multiple questions so we can best understand your situation  to come alongside you & serve your family. Our program also operates on a needs – based criteria, so the questions are only to help ensure your situation is best represented.                                                                                                             You must complete this entire form before exiting.  You can't complete a portion and return to finish. This form will take approximately 15 minutes to complete.                                Again, thank you for your interest in our program.
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Email *
Primary Contact Name and Phone Numbers:  H=Home  C=Cell  W=Work   M=Message *
Drop off location if different than home and directions to that location
Secondary Contact Name and Phone Numbers:  H=Home  C=Cell  W=Work  M=Message *
Mailing Address (ONLY if different from Living Address)
Legally Married *
Preferred Method of Child Transportation to School:
Pick up location if different than home and directions to that location
Applicant's Race (choose all that apply) *
Required
Living Address: City *
County *
Living Address: Zip Code *
Applicant's Primary Lanuage *
Applicant's (child) Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Names *
School District you live in (Home District)?  *Mayfield or other Home District will require Board of Education approval for enrollment.
Clear selection
Preferred Name
Applicant's (child) Legal FIRST Name *
Applicant's (child) Gender *
Preferred School District?  *Will require Board of Education approval if other than Home District.
Clear selection
Mailing Address: Zip Code
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 (child) Legal LAST Name *
Applicant's English Proficiency *
Living Address: Street Address *
Mailing Address: City
Secondary Contact Email *
I give permission to contact me via cell/text/e-mail regarding information on my child and school activities.  Choose all that apply *
Required
Primary Contact Email:
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