Child Enrollment & Health Information Form

Our After Care program is licensed under the Day Care licensing and therefore every student must have their official enrollment form completed.

Please note, if you check “Yes” for any allergies or special health conditions on Page 2, you will need to fill out an additional form for “Child Medical/Physical Plan” so let us know.

Please click on this link to find the form.  You can fill it out online and then print it and hand it in, or you can Download it as an empty form and then fill it out by hand.  

http://www.odjfs.state.oh.us/forms/file.asp?id=181&type=application/pdf