Carlisle HIPPY 2026-2027 Pre-Registration Form

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Carlisle HIPPY 2026-2027 Pre-Registration Form

HIPPY is a FREE home-based preschool program for families in the Carlisle School District with children ages 2-5. All supplies, books, lesson packets, etc. are delivered to your home each week at absolutely no cost to you!

By filling out the form below, this will let us know that you want a spot for the 2026-2027 school year for your child. Once we have this information, we will then contact you once we come back after summer break.

Then, you will fill out our required paperwork, and turn in copies of the following REQUIRED documents:

- Child's Birth Certificate (hospital birth card does not work, it must be a state issued certificate)
- Child's Social Security Card
- Child's most recent Well Child Check
- Child's shot record

- Proof of Income- provide one of following- current 30 days of pay stubs, previous year’s income tax form, employer statement of income on letterhead, or W-2

We must have these documents, as they are required by the State. Carlisle HIPPY is offered FREE to the families within the Carlisle School District area. Your child must be at least 2, 3 or 4 by December 31st.

* If you have more than one child that will be in the HIPPY Program for the 2026-2027 school, please fill out a form for each child separately. Thanks!

Parent's First and Last Name *

Child's First and Last Name *

Child's Date of Birth *

Is your child *

Male

Female

Address (Street Address) Where Visits Will Be Done (Grandparent, Caregiver, Home, etc.) *

If you have a different mailing address, please let us know (including the city):

Phone Number (that can receive texts) *

How many people are in your family? Family means parents/caregivers and children only. This number could be different than the number of people in your house. For example, if two children live with two parents, and a grandparent also lives in the house, the number in the family would be 4 even though the number in the household would be 5. *

Do any of the following apply to you or your family?
*

I do not have a high school diploma or GED

My child was below 5 lbs. 9 oz. when born

Child is in custody or living with a family member other than the parent (parent is not in the household)

Child has parent activated for overseas military duty

Parent was under 18 years of age at birth of child

Child is a foster child

Child has immediate family member (mother, father, sister, brother) arrested or convicted of drug related offense.

Family member has ever been in a treatment center for substance abuse and/or addiction

Child already has an IEP and receiving services from the co-op or another facility

Family member or child has a history/been a victim of abuse or neglect

Parent has Limited English Proficiency

None of these apply

Required

You have read and understand that we are required to obtain the following 5 documents:

-Child's Birth Certificate

-Child's Social Security Card/Number

-Child's Latest Physical/Well Child Check

-Child's Shot Record

-Proof of Income

Yes

Required

Notes (Optional):

Submit

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