Child Enrollment Form - SKCDC

Administration Office

337 Maine Avenue
Farmingdale, ME 04344

207-582-3110

toll-free: 800-525-2229
fax: 207-582-3112

Parent/Guardian

First Name

Last Name

Birthday

Gender

Email Address

Phone1

Phone1 Type

Phone2

Phone2 Type

Phone3

Phone3 Type

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Address

Is your family Experiencing Homelessness?

Living Address

Address Line 2

City

State

Zip Code

Family Information

Number of Parent/Guardians

Relationship to Participants