Application Form

All classes are currently full.

This application information will need to be filled out and received prior to your child being placed on a waiting list.

Please fill out the form.

Child's Information

Parent/Guardian Information

Emergency Contact

Release Guardians

I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name and telephone number for each. Children will be released to a parent or person designated by the parent/guardian after verification of ID.


I understand that the following meals will be served to my child while in care:

My Child is Normally in Care on the Following Days and Times:

Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to: