Child Enrollment

Location Selection:(Required)

The Commonwealth of Massachusetts
Department of Early Education and Care

Child’s Enrollment Form

Child Information

Child’s Name:(Required)

Date of Birth:(Required)

Age at Admission:(Required)

Date of Admission:(Required)

Child’s Home Address:(Required)

Home Phone Number:(Required)

Primary Language:(Required)

Identifying Marks:(Required)

Eye Color:(Required)

Hair Color:(Required)

Skin Color:(Required)

Sex:(Required)

Height:(Required)

Weight:(Required)

Parent/Guardian Information

Parent/Guardian Name:(Required)

Relationship to Child:(Required)

Home Address:(Required)

Reachable Phone Number:(Required)

Email Address:(Required)

Business Name:(Required)

Business Address:(Required)

Business Phone Number:(Required)

Hours at Work:(Required)

Parent/Guardian Name:

Relationship to Child:

Home Address:

Reachable Phone Number:

Email Address:

Business Name:

Business Address:

Business Phone Number:

Hours at Work:

Additional Information

Child’s Physician:(Required)

Address:(Required)

Phone Number:(Required)

Allergies/Special Diets?(Required)

Individual Health Plan for child with a chronic health condition? If yes, please attach.(Required)

File Attachment:

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 30 MB.

(Individual Health Plan for child with a chronic health condition)

Copies of any custody agreements, court orders, and restraining orders pertaining to the child? If yes, please attach.(Required)

File Attachment:

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 30 MB.

(Copies of any custody agreements, court orders, and restraining orders pertaining to the child)

Special limitations or concerns?(Required)

School Age Only

Current School:

School Address:

School Phone Number:

Parent/Guardian initials:(Required)

Parent/Guardian Signature:(Required)

Date:(Required)

Child Enrollment

KBLC Kingston

KBLC Norwell

KBLC Pembroke

KBLC Plymouth

KBLC Carver

KBLC Kingston

KBLC Norwell

KBLC Pembroke

KBLC Plymouth

KBLC Carver

KBLC Hanover

Have Questions?

KBLC Kingston

KBLC Norwell

KBLC Pembroke

KBLC Plymouth

KBLC Carver

KBLC Hanover