Enroll Your Child(ren) with Us

We’re excited to welcome your family to our nurturing and educational environment. Please complete the enrollment form below to start the process and give your child(ren) the best start in their learning journey.

PARENT INFORMATION

First name

Last name

Phone

Child Care Payments will be paid through

Which location would you like your child(ren) to attend?

How did you hear about Safe Haven Ministries, Inc.?

FAMILY INFORMATION

Are you the:

Mother/Father/Grandparent/Foster

Family Size

Number of parents/adults in the home

HOURS OF SERVICE NEEDED

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

CHILD INFORMATION

Child #1

First Name

Last Name

Gender

Age

Birth Date

Month

Day

Year

Any special needs, schedules (such as before and after school), transportation, or additional services required? Please-explain.

Child #2

First Name

Last Name

Gender

Age

Birth Date

Month

Day

Year

Any special needs, schedules (such as before and after school), transportation, or additional services required? Please-explain.

Child #3

First Name

Last Name

Gender

Age

Birth Date

Month

Day

Year

Any special needs, schedules (such as before and after school), transportation, or additional services required? Please-explain.

Make an Appointment

We're here to answer your questions and welcome you to our community. Reach us by phone, email, or drop by our center. You can also fill out this form right here and we will get back with you ASAP.

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