Application for Enrollment

If you are enrolling in T's Learning Center please complete the form below.

If you are looking to find out more informaton please fill out a tour form.

Family Information

Emergency Contact and Pickup


Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of Illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached: Authorized person must be 18 years or older.

Name Relationship Address Cell Phone
Student #1

Student Information

Medical Information

I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Physician Information:

Section 65C-22.006 (2), F.A.C., requires a current physical examination (Form 3040) and immunization record (Form 680 or 681) within 30 days of enrollment. If these forms have not been received upon the child's first day, the parent/guardian will be required to provide documentation that an appointment has been made to obtain these required forms.

Section 402.3125 (5(, F.S., requires that parents receive a copy of the Child Care Facility Brochure, KNOW YOUR CHILD CARE FACILITY. (CF/PI 175-24)

Section 65C-22.006 (3) 2. F.A.C., requires that parents are notified in writing of the disciplinary practices used by the child care facility and the explusion policy.