Enrollment Inquiry Educare Central Maine Enrollment Inquiry Form A staff person will follow-up to obtain additional information needed to complete enrollment, contingent on eligibility and space availability. Parent/Guardian InformationName(Required) First Last Address(Required) Street Address City ZIP / Postal Code Phone (must include phone or email)Email Relationship to Child(Required)Biological/Adopted/Step ParentFoster ParentGrandparentOther RelativeOtherDo you have custody of child?(Required) Yes No General Family InformationIs your family experiencing homelessness?(Required) Yes No Is your family receiving (check any/all that apply):(Required) TANF SSI WIC SNAP None of the above # of people in household(Required)Family Annual Income (before taxes)(Required)ProgramPreferred Program(Required) Full-day Care Part-day Preschool Not sure Child InformationDue DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Name(Required) First Last Child's Birthdate(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you have another child you'd like to enroll?(Required) Yes No Child #2 Name First Last Child #2 BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Comments
