CHILDCARE PAYMENT ASSISTANCE:
Important Note for DSS Families:
DSS will NOT pay the one-time Activity fee of $75 for each child due upon receipt of enrollment. Please make sure to leave your payment information to process this fee when asked on this enrollment form! DSS may or may not pay each child's registration fee. If they do not pay, the parent is responsible for paying the $25 per child. All monthly co-fee's are outlined by social services, speak with your worker to determine if you will or will not have one.CHILD INFORMATION:
MEDICAL INFORMATION & CONSENTS:
Parent Information:
AUTHORIZED EMERGENCY CONTACTS:
MUST Provide 2 Emergency Contacts that live within 1 hr of child's location. CANNOT BE PARENT/GUARDIANS!
PARENTAL AGREEMENTS & CONSENTS:
PAYMENT METHOD & CREDIT INFORMATION