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Jefferson Child Care and Education Center

Infant / Toddler / Preschool Registration

Complete the program required forms and return them to the Center.

  • Fee Agreement (Download Form)
    Complete both pages and return to the Center.
  • Children’s Emergency (Download Form)
    Complete entire form.  The signatures of those individuals you are authorizing to pick up your child are not required at this time.  The first time they pick up your child, they will be required to show identification and their signature will be obtained. 
  • Emergency Medical Consent (Download Form)  
    Complete entire form and return to center.
  • Universal Health Record (Download Form)
    Complete Section 1 before sending to child’s physician for his/her completion. Please have physician attach immunization records.
  • Child’s immunization record
    The immunization record is provided by the child's physician. Please attach the immunization records to the Universal Health Record..
  • Admissions record (Download Form)
  • Receipt of Information Statement (Download Form)    
    Complete entire form and return to center.
  • One Call System (Download Form)