Arkansas Better Chance For School Success

We have a new application!
Click below to go to be redirected to our brand new application! It is our goal to narrow down all the paperwork you would usually fill out to register. Please be aware that there is a save button on each page of the form if you need to save to continue for later. Also, an uploaded picture of your child's birth certificate will be required to submit the form.
Arkansas Better Chance For School Success
Please select the Preschool of your choice?*
How did you find out about our program?*

Child Information
Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Language*
Please select the language skills of your child.*
Ethnicity/Race*
US Citizen*
Social Security Number*
Medical Insurance*
ARKIDS Number
if applicable
Has your child attended a state funded pre-k (ABC) program before?*
If so, where?
if applicable
Will this child be concurrently enrolled in an ABC center and HIPPY or PAT program?*
If so, which HIPPY or PAT Program?
if applicable
List any allergies (food, insects, etc...)*
if applicable
Does the child have any special dietary needs?*
if applicable
Receiving any special education services?*
if applicable

Primary Guardian Information

Name(s) of person(s) with whom child is living
1st Primary Guardian
Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Language*
Ethnicity/Race*
Marital Status*
Last 4 of Social*
Receiving Food Stamp/SNAP
Receiving WIC
Email*
example@example.com
Phone Number*
Consent to Text Messages
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address the same as the physical address?
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Status*
Employer*
Work Address*
Education Level*
If attending school, where?
Semester Hours
Current Housing
Date

MonthDayYear
Date
Primary Caregiver Insurance Name*
Income*
Has family moved in 24 months?*
Disabled?*
Veteran of United States Military?*
Member of US Military on active duty?*
2nd Secondary Caregiver Information

(2nd Parent or Guardian in household with child and is used for determining eligibility)
Will there be a secondary caregiver?*
Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Language*
Ethnicity/Race*
Last 4 of Social*
Email*
example@example.com
Phone Number*
Consent to Text Messages
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the mailing address the same as the physical address?*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education Level*
If attending school, where?
Semester Hours
Employment Status*
Employer*
Work Address*
Primary Caregiver Insurance Name*
Income*
Disabled?*
Veteran of United States Military?*
Member of US Military on active duty?*

Household Information
Number of people in the family*
Number of people in the household*
1. Name

First NameLast Name
Relationship
2. Name

First NameLast Name
Relationship
3. Name

First NameLast Name
Relationship
4. Name

First NameLast Name
Relationship
5. Name

First NameLast Name
Relationship
6. Name

First NameLast Name
Relationship
7. Name

First NameLast Name
Relationship
8. Name

First NameLast Name
Relationship

Emergency Contact and Consent Information
Emergency Contact

(if parent/guardian cannot be reached)
Name*

First NameLast Name
Relationship to child*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician Contact
Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Consent for Emergency Medical Care
Primary Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Signature
I declare under the penalty of perjury and the rules and regulations of the Arkansas Better Chance program that the information supplied is true and correct at the time of application. I understand that the information I supplied may be independentlyverified by the Arkansas Division of Child Care and Early Childhood Education and that any false statements may result in exclusion from DHS programs and criminal prosecution.
Primary Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Please select all that apply.

I give permission for my child to be photgraphed for preschool use.I give permission to use pictures or videos of my child on Social Media (Preschool Facebook Page)I have received a Kindergarten Readiness CalendarI have received the Preschool Handbook.I give permission to apply sunscreen to my child.I give permission for my child to be screened by South Central Service Cooperative and information to be released. The following four areas will be screened: hearing, vision, developmental and speech.
Kindergarten Readiness Calendar and Preschool Handbook can be downloaded below by clicking the down arrow.
Kindergarten Readiness Calendar
Preschool Handbook

Enrollment Documents

These are the documents that will be required for enrollment. Uploading these documents will save time and make the acceptance process quicker. If you do not have a scanner then you can take a CLEAR picture of the documents. If needed, we will request a clearer document.
Legal Birth Certificate

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Social Security Card

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Proof of Income

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Health Screening

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Immunization Record

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Should be Empty:

We have a new application!

Arkansas Better Chance For School Success

Child Information

Primary Guardian Information

1st Primary Guardian

2nd Secondary Caregiver Information

Household Information

Emergency Contact and Consent Information

Emergency Contact

Physician Contact

Consent for Emergency Medical Care

Signature

Kindergarten Readiness Calendar and Preschool Handbook can be downloaded below by clicking the down arrow.

Enrollment Documents