JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PRIME TIME HEAD START Parent Interest Form
We are so happy that you are interested in applying for our NO COST pre-school program for 3 and 4 year olds in Ouachita Parish!
Sign in to Google
to save your progress.
Learn more
* Required
Which school year are in interested in?
*
THIS school year 2021-2022.
NEXT school year 2022-2023 starting in August.
What event did you attend, or how did you discover PRIME TIME HEAD START? (Event name or person's name)
*
Your answer
Child's LAST name
*
Your answer
Child's FIRST name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Gender
*
Female
Male
Prefer not to say
Other:
Parent/Guardian LAST name
*
Your answer
Parent/Guardian FIRST name
*
Your answer
Parent/Guardian Date of Birth
*
MM
/
DD
/
YYYY
#1 Phone Number to reach Parent/Guardian (Include AREA CODE)
*
Your answer
#1 Phone- May we text you at this number?
*
Yes
No
#2 Phone Number to reach Parent/Guardian (Include AREA CODE)
Your answer
#2 Phone- May we text you at this number?
Yes
No
Clear selection
Mailing Address/Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
What is your #1 choice location to attend?
*
MLK
RANSOM
ROBINSON
THOMAS & WILSON
What is your #2 choice location to attend?
*
MLK
RANSOM
ROBINSON
THOMAS & WILSON
What is your #3 choice location to attend?
*
MLK
RANSOM
ROBINSON
THOMAS & WILSON
What is your #4 choice location to attend?
*
MLK
RANSOM
ROBINSON
THOMAS & WILSON
This is NOT an application, but this valuable information makes it possible for us to follow-up with you to start the application process! THANK YOU SO MUCH! Someone will be reaching out to you within 2 business days!
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of PRIME TIME Head Start.
Report Abuse
Forms
