Enrollment | DSECC

PreEnrollment Application

Please complete the form to help us correctly place your child. Children listed on your submission will be added to our waiting list if we do not currently have space.

Child's Name (1)

Date of Birth (1)

Child's Name (2)

Date of Birth (2)

Parent/Guardian Name

How many total family members are in your household?

Parent Emails

Phone number

What childcare options have you used previously?

Why are you currenlty looking for childcare?

How many days a week would your family need care?

Does your family qualify for Child Care Works subsidies through the State?

What additional financial assistance will your family need to afford care?

Is your child currently meeting all milestones for their age? If not, what accommodations are in place?

Does your child have any dietary restrictions or allergies?

Please add any additional information you would like us to have.

By checking this box I agree that all information provided is true and complete to the best of my knowlege.

Thanks for submitting!

1311 Diamond Street

Akron, PA 17501

Phone

717-859-4272

Angie@diamondstreet.org

Diamond Street Early Childhood Center

Where Children Shine

PreEnrollment Application