Little Lions Learning Center Application Form

Little Lions Application Form
Items to Return for Enrollment
- Shot Record (Can be faxed to 606-729-0637)
- First Week’s Payment
- State Financial Contract
State Assistance Information:
- State Deparment Information Below:
  - 855-306-8959
  - Website: https://kynect.ky.gov/benefits/s/child-care-program?language=en_US
- Little Lions Learning Center Information:
  - License Number: L384117
  - Address: 420 Lily School Rd. Lily, Ky. 40740
  - Phone Number: 606-261-7558

Child Information
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Guardian Information

Please note that the individual listed here will be permitted to sign child out
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Will your child be state assisted or parent pay?
How did you hear about us?

Other
Please click the link below to view our handbook
LLLC Parent Handbook
Should be Empty: