Phone 814-670-0838

Preschool Enrollment

Thank you for your interest in enrolling your preschooler with Child Development Centers, Inc. 

Please fill out the information below and an enrollment specialist will follow up with you as soon as possible. 

First Name *
Last Name *
/
/
Country
Address Line 1 *
City *
State/Province *
Postal Code *
First Name *
Last Name *
Relationship to Child
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Phone
Did your child attend an Early Head Start Program?
Did your child attend another Head Start Program? (If yes, please site below)
Is your child involved with Children, Youth, & Families?
Is your child a Foster Child?
Do you have a Custody Agreement?
Do you have educational rights?

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Gross Annual Income
SSI
Is your family receiving Supplemental Security Income (SSI)?
SNAP (Food Stamps)
Is your family receiving SNAP benefits (Food Stamps)?
TANF
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Number of People Living in the Household
Do you have any special needs or concerns for your family such as (check all that apply)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Is your family (check all that apply)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Does your child have an educational, medical or mental diagnosis? (Check all that apply)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Do you have an educational or behavioral concern for your child or yourself? (Check all that apply)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

CDC requires all young learners to receive their Primary Immunizations: https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf.
This does not include the COVID-19 vaccine.

Has your child received their recommended immunizations?
How did you hear about us?
2335 West 38th Street
Suite 1
Erie, PA 16506
Phone 814-670-0838

© Child Development Centers, Inc. 2022

Crafted by Firespring