Early Education Pre-Registration

Step 1 of 4

The intent of this pre-application is to gather basic information about your child and family to help the Kennedy Center staff better support your needs. The information requested below will allow our staff to better identify program options available to you. This pre-registration form does not include all information that will be required for registration.

Please submit 1 form for each child you wish to enroll.

Please allow up to 2 business days for a response after submitting this form. Review the Required Documents for Enrollment for information needed to process your application.

Name of Person Completing this Form:(Required)

First Last

Child's Name(Required)

First Last

Child's Date of Birth(Required)

Parent/Guardian Information

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Is there a second parent living in the home?

Yes

Name of second parent(Required)

First Last

Email of second parent(Required)

Parent/Guardian Information

Family Information