Select the Center You're Enrolling In:
*
Please Select
Veteran's Location (Center 1)
Rankin Location (Center 2)
Section 1 – General Information & Important Notice
Director's Name (This will auto populate, once you select the center at the top)
Please Select
Elizabeth Jones
Lakendra Moore
Child's Name
*
Date of Admission
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Parent or Guardian 1
*
Parent Email Address
*
example@example.com
Parent 1 Area Code and Phone No.
*
Format: (000) 000-0000.
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📋 How to Complete Your Required Enrollment Forms
📢 To finalize your child's enrollment, the required state compliance packet must be filled out completely. We offer two convenient ways for you to complete these documents:
*
Option 1: Complete Over the Phone with a Representative (Preferred) – Fast, convenient, and highly recommended.
Option 2: Complete In-Person at the Center
Need a hand filling this out? 📞State compliance forms can be overwhelming! If you would prefer to complete this packet over the phone with us, simply pick a time below to schedule an enrollment assistance call.
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