PLEASE COMPLETE THE INFORMATION BELOW AND THEN CLICK THE "SUBMIT" BUTTON.  A MEMBER OF THE

HEAD START/EARLY HEAD START ENROLLMENT TEAM WILL CONTACT YOUR FAMILY TO BEGIN THE ENROLLMENT

PROCESS.

Child's Last Name:

Child's First Name:

Child's Date of Birth:

Parent/Guardian Last Name:

Parent/Guardian First Name:

Home Phone:

Cell or Business Phone:

Preferred Method of Contact:

.Click Here to go to Enrollment Page:

Please SelectHome PhoneCell or Business Phone

Website Designed at Homestead™ an Intuit Company Create a Website and List Your Business