Fillable Early Childhood Education Center (Mississippi Gulf Coast Community College)

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Early Childhood Education Center (Mississippi Gulf Coast Community College)

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Country of origin: US
File type: PDF

U.S.A. forms for Mississippi Gulf Coast Community College

BROWSE MISSISSIPPI GULF COAST COMMUNITY COLLEGE FORMS
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Early Childhood Education Center
§ All forms listed below must be completed and returned:
• Application for Enrollment
• Registration Form
• 121 Immunization Form
• Proof of Guardianship (birth certificate)
• Parent’s Class Schedule
§ One parent must be a full-time student.
§ If we are unable to reach you when a space becomes available, we will
contact the next person on the list. Please update phone numbers with us as
we have no other way to contact you!
v Once you are notified that a space is available, you will be required to pay for
the first week of the next semester (this payment is non- refundable) and bring
a copy of your schedule to the child care center.
Acceptance will be determined by date and time application is received.
Spa
ce is limited.
HOURS OF OPERATION: 7:30 A.M. TO 3:15 P.M.
COST FOR CHILD CARE:
$75 PER WEEK PER CHILD
Early Childhood Education Center
Registration Form
Child’s Name: _____________________________________________ Date of Birth: __________________
Call Name: ________________________________________________
Child’s Age: _______ 1 year old ________2 year old ________3 year old _______4 year old
Student Name: _____________________________________ Student M #: __________________________
Mother is: ____Full-Time Student ________________________________________ ____Not a Student
(Academic or Program Major)
Mother’s Name_____________________________________________________
Home Phone:_________________ Cell Phone: _____________________ Work Phone: _______________
Email: ______________________________________________________
Father is:
____Full-Time Student________________________________________
____ Not a Student
(Academic or Program Major)
Father’s Name_____________________________________________________
Home Phone:_________________ Cell Phone: _____________________ Work Phone: _______________
Em
ail: ______________________________________________________
Parent’s Signature: ___________________________________________ Date: _______________________
*****************************************************************************************
* For office use only:
_____ Student Schedule _____ 121 Form ______ Birth Certificate ______ Application for Enrollment
Date of Registration: ______________________________
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Early Childhood Education Center (Mississippi Gulf Coast Community College)

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Completed 3 February 2021

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