Home Address (House #, Street, City, State, Zip Code) *
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Parent/Guardian primary phone number *
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Parent/Guardian primary Email address *
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Elementary Building Student will attend during the 2022-2023 school year *
Name and Grade of Siblings currently enrolled in Child Care program *
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Which Child Care Times are you applying for? *
In compliance with our state child care licensing rules, we will send out additional required paperwork over the summer. This paperwork must be completed and returned prior to your child attending the fall program. PLease be on the lookout for this paperwork to arrive via snail mail sometime towards the end of July. Directions on how and where to return this paperwork will be included in the packet.
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