Enrollment Forms

Please only Print and Complete these Enrollment Forms to bring in if we have already set up an appointment time through text message for you to come by and verified we do have a spot open for your child to enroll. You can text to see if there are Open Spots for Enrollment by messaging

(304) 549-0451. Thank You!

 

 

The following forms are required to be on File by West Virginia State law and need to be completed prior to placement.

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1. The Emergency Information/Pickup Permission Form

(This sheet MUST be notarized before it is returned to me. It is the State Law.)

2. Parent Agreement Form

3. Current Immunization Records & a Copy of Child's Last Well Visit

4. Media Release Form

5. Signed & Notarized Client Contract

6. Pest Management Notification Form

7. Enrollment Questionnaire Form

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A $50.00 non – refundable registration fee (this is due for Private Pay & LINK enrollment) along with a completed registration packet will be due at least 24 hours before your child can begin attendance. This allows us to be able to learn about your child before they arrive to our program. This Fee is Due Annually and to be paid at time of initial Enrollment & again every August to renew your Enrollment & Contract for your child's spot. This is due for Private Pay clients as well as LINK/CONNECT clients.

 

 

It is the parent's responsibility to keep the immunization form up to date. According to state regulations this form must be updated and returned to the provider within 24 hours of receiving shots.

You are required to keep us informed of any change in addresses, telephone numbers, and other pertinent information listed on any/all of the above forms.

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Please inform us if your child has ever had fever related seizures, other serious medical conditions or food allergies.

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To Download & PRINT our Enrollment Forms please click on the Button Below. Call Us to Schedule a Time to Bring it to us. THANKS!