Step 2

Online Application Form

    Hanover Elementary School
    6:45 am to 8:45 am
    3:20 pm to 5:30 pm
    Nathan Hale Elementary School (M-Th)
    6:45 am to 8:45 am
    3:20 pm to 6:00 pm
    Nathan Hale & Pulaski
    Close at 5:30 on Fridays
    HaleHanoverPulaski
    AMPMAM & PMDrop-in
    WebsiteNewspaperReferralReturning familyFlyerOther

    * Please provide the following information about your child/family. It is required for statistical purposes only because our agency receives state funds. It does not affect your admission to our program in any way.

    Family Composition


    GuardianFoster Parent1 parent2 parent'sWorkingOther

    TFACCAPJobs FirstOther

    The following are all required. Return completed form with documents to the Program Manager. Incomplete applications will not be processed.

    Enrollment Information

    BoyGirl

    Guardian 1

    Self-EmployedUnemployment

    Guardian 2 (if applicable)

    Self-EmployedUnemployment

    The Following information is used to help determine which level you will fall into for our tuition rates:

    Family Composition

    Parent/Guardian 1Parent/Guardian 2BothShared 50/50

    Parent/Guardian Signature:

    By signing I am saying that all the above information is accurate as of date of enrollment.

    Emergency Contacts
    ** Contacts must be different than the above guardians.**
    *** 3 different emergency contacts are required.***

    The following people are authorized to pick-up my child (ren) and be contacted in case of emergency.

    (Must be 18 or older)

    I understand that if another individual comes to pick up my child that is not listed on this form, they will not be able to take the child. You may add other pick up people at any time via a note given to the program manager.