Registration 

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• Registration Application (create an account and complete for each child you are interested in enrolling)

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Household Information

 

•  Household Composition Form 

 

Exams/Releases

• Medical Authorization to Release Information Form 

• Completed Child Examination Form (6 weeks – 5 yrs.) Required screenings and shot records

 

• Dental Authorization to Release Information Form 

• Completed Dental Examination Form (2½ yrs. – 5 yrs.)

 

 

Income Verification (Most Recent 30 Days)

 

• Pay Check Stubs

                                     or

• Statement from employer on company letterhead (state date, pay rate, schedule)

                                    or

• Self-Declaration Affidavit Form

                                    or

• Proof of unearned income (ex: OWF, temporary disability, unemployment)

                                    or

• Zero Living Expense Statement Form 

 

Schedule

 

•  Work/School Schedule on company letterhead (If applicable)

 

Child's Age Verification

 

• Birth Certificate

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Parent/Guardian Identification

​

• Valid picture I.D

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Do You Have PFCC (Title XX) or Want to Apply?

​

• ODJFS 1401

​

• PFCC (Title XX) Application

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