Child Care Registration

If we are unable to reach you when a space becomes available, we will contact the next person on the list. Please contact us with any changes to your phone number.
Once you are notified that a space is available, you will be required to pay for the first week of the next semester (this payment is non- refundable) and bring a copy of your schedule to the child care center if you have not already submitted it.
You may submit your class schedule with this registration form at this time, if available. Once space is available, you must complete and return these forms:
- Application for Enrollment
- 121 Immunization Form (see MSDH's MyIR page for more information)
- Proof of Guardianship (birth certificate)
- Parent’s Class Schedule (if current not on file)

Acceptance will be determined by date and time application is received.

Space is limited.

Early Childhood Education Center

Campus*

Select the campus for the Early Childhood Education Center where you would like the child to attend.

Name*

First Middle Last

Call Name

Name child answers to.

Child's Date of Birth*

Would you like to add another child?*

Second Child's Name*

First Middle Last

Second Child's Call Name

Name child answers to.

Second Child's Date of Birth*

Name*

First Middle Last

Cell Phone*

Home Phone

Email*

Enter Email Confirm Email

Relationship to Child*

Academic Status*

Student ID Number (M#)*

Academic or Program Major*

Class Schedule Upload

If available, please provide a copy of your class schedule.

Max. file size: 5 MB.