Child Registration | Little Stars

Child Registration Form

Child's Name

Age

Birthdate

Address

Mom's Name

Dad's Name

Mom's home #

Mom's cell #

Mom's work #

Dad's home #

Dad's cell #

Dad's work #

Date of Enrollment

Payment Received: $

Date

I understand, in addition to the first week's tuition, there is a $25.00 non-refundable fee to enroll my child in Little Stars early learning center. This is the only way to guarantee my child/rens position. If I should chose to dis-enroll my child, I will not be refunded either of these payments. The registration fee will not be applied to my account, but the tuition payment will cover the first week.

I have read and understand the terms of the registration policy.

Signature

Date

Approved by

****************************************************************************************************************************************

Office Use Only

Health Care Summary was received on

Immunization form was received on

Click the button at below right for detailed instructions on filling and submitting forms. You must use Adobe Acrobat Reader for the forms to properly function. Click the button below left to install a free copy of Acrobat Reader on your computer. This action will take you to the Adobe Acrobat Reader installation page. Uncheck the optional offers, click “Install Now,” and follow the instructions. Forms highlighted in blue are not electronically fillable and should be printed and completed with pen and ink.
	Get Acrobat Reader		Detailed instructions for filling/submitting forms

CHILD REGISTRATION AND ENROLLMENT

REGISTRATION
1. Child Registration (LS-201)	Download	2. Parent Handbook	Download

ENROLLMENT
1. Contract for Services (LS-206)	Download	2. Tuition Express Account Registration (LS-101)	Download
3. Electronic Key Fob Application (LS-102)	Download	4. Parent Agreement (LS-205)	Download
5. Child Enrollment (LS-202)	Download	6. Health Care Summary (LS-204)	Download
7. Child Care Immunization Form (LS-215)	Download	8. CACFP Infant Meal Preferences (LS-216)	Download
9. CACFP Enrollment (LS-217)	Download	10. CACFP Household Income Statement2	Download

SPECIAL CONDITIONS
1. Release to Administer Medication (LS-207)	Download	2. Special Diet (LS-208)	Download
3. Individualized Child Care Plan (LS-218)	Download	4. Parent Consent for Swaddling (LS-219)	Download
5. Parent Release for Rolling Over (LS-220)	Download	6. Physician Directive for Sleep Position (LS-221)	Download

CHILD CARE ASSISTANCE PROGRAMS
1. Child Care Assistance Program (MN-DHS-3550)1	Download	2.

Notes:
1 – These forms are fillable but require that you manually save and print them for filing & signature.
2 – These forms must be printed, completed with pen & ink, signed, and submitted.