Child's Name
*
Date of Birth
*
Gender
*
Male
Female
Age
*
Home Telephone
Cell Phone
Email Address
Physical Address
*
City, State, Zip
*
If mailing address is different that physical address, please fill out mailing address below.
Mailing Address
City/State
Person child resides with
*
Relationship to Child
*
Domiciliary Parent or Guardian
*
Ranking a program 1st or 2nd DOES NOT guarantee enrollment.
Enrollment can be limited by factors including availability of seats and preference for siblings/residential area
Child's Legal Name
*
Name of Parent/Guardian
*
By filling in your name below, that will serve as your signature to the application.
Parent/Guardian Signature:
*
Date
*
Please rank your top 3 programs in order of preference. 1 being 1st, 2 being 2nd, 3 being 3rd, and if not your choice please mark not preferred.
Only rank programs for which you are eligible:
Type III Daycare
1, 2 Buckle My Shoe- Marksville
not preferred
1
2
3
Bayou Chateau Child Development Center- Simmesport
not preferred
1
2
3
Cribs to Crayon 2- Cottonport
not preferred
1
2
3
Little Shining Stars 2- Bunkie
not preferred
1
2
3
Nay's Childcare & Preschool Center- Mansura
not preferred
1
2
3
Nay's Infant Center- Mansura
not preferred
1
2
3
The Early Childhood Development Center (ECDC)- Mansura
not preferred
1
2
3
Toddle Town Day Care- Hessmer
not preferred
1
2
3
Early Head Start & Head Start
Cinderella Head Start
not preferred
1
2
3
Humpty Dumpty Head Start/ Main Office
not preferred
1
2
3
Jack & Jill Head Start
not preferred
1
2
3
Little Bo Peep Head Start
not preferred
1
2
3
Mother Goose Head Start
not preferred
1
2
3
Mother Hubbard Head Start
not preferred
1
2
3
New Beginnings Head Start
not preferred
1
2
3
Brook's Child Development Early Head Start / Head Start
not preferred
1
2
3
Avoyelles Head Start Center- Type: CHILD CARE
not preferred
1
2
3
Cribs to Crayon- Bunkie- Type: CHILD CARE
not preferred
1
2
3
Avoyelles Parish School Board- Type: PRE-K PROGRAM
not preferred
1
2
3
Public Pre-K
Bunkie Elementary
not preferred
1
2
3
Cottonport Elementary
not preferred
1
2
3
Lafargue Elementary
not preferred
1
2
3
Marksville Elementary
not preferred
1
2
3
Plaucheville Elementary
not preferred
1
2
3
Riverside Elementary
not preferred
1
2
3
*
indicates required fields