Required Form

Child's Application for Enrollment

NC Division of Child Development & Early Education · Revised 10/2016

Fill this out for each enrolling child — a tour is not required. Your answers save in this browser. When you submit, you'll get a reference number to use on the other enrollment forms, plus a signed PDF for your records.

Have a reference number?

If you requested a tour or already started enrollment, enter your reference (looks like hls-2026-XXXXXXXX) and the email on file to pre-fill family details. Otherwise, fill the form below — we'll create a reference when you submit.

Child information

Date of birth*

Date application completed

We'll fill in today's date if left blank.

Child's full name*

Last*

First*

Middle

Nickname

Child's physical address*

Family information

Child lives with*

Father / Guardian

Name

Home phone

Address (only if different from child's)

Zip code

Work phone

Cell phone

Mother / GuardianLeave blank if not applicable.

Name

Home phone

Address (only if different from child's)

Zip code

Work phone

Cell phone

Authorized pickup & emergency contacts

Your child will be released only to the parents/guardians above and the people you list here. These contacts will also be called in an emergency if we can't reach you.

Contact 1(at least one required)

Name*

Relationship

Address

Phone number*

Contact 2

Name

Relationship

Address

Phone number

Contact 3

Name

Relationship

Address

Phone number

Health care needs

If your child has health care needs such as allergies, asthma, or other chronic conditions, a medical action plan completed by your child's parent or health-care professional should be attached.

Is a medical action plan attached?

YesNo

Allergies and the response required for allergic reactions

Other health care needs or concerns

Particular fears or unique behavior characteristics

Medications taken for health care needs

Anything else relevant for safe medical treatment

Emergency medical care

Name of health care professional*

Office phone

Hospital preference

Hospital phone

Authorization & signature

Parent / guardian printed name*

Your full legal name as it should appear on the form.

Signature*

Use your finger or mouse to sign in the box above.

Sign with your finger or mouse in the box below. This will appear on the printed PDF.

Signature date

We'll fill in today's date if left blank.

Your email*

We'll use this only to confirm receipt of your form.

I, as the parent/guardian, authorize Happy Little Scholars Academy to obtain medical attention for my child in an emergency.

I confirm that the signature I drew above is my electronic signature on this form.

Your answers are saved automatically in this browser only. They're cleared once you successfully submit.