Harnett County Cooperative Extension

Harnett County Child Care Resources

126 Alexander Dr., Suite 300, Lillington, NC 27546
910-893-7530

Bringing parents, child care providers and community together for the sake of our children.

School-Age Rhythm & Rhyme

Interest Form
Name of Child Care Program: ________________________________________
Phone Number: ____________________________________________________
Address: __________________________________________________________

Please answer questions below:

Has your program participated in an ABC Music & Me program with Harnett County Child Care Resources?
__________
How many are currently enrolled in the School-Age group / classroom you selected to participate in the School-Age
Rhythm & Rhyme?
__________
Are there any military children involved in the School-Age group / classroom? If yes, how many?
__________

I _________________________________________ am verifying that the information listed above is accurate and

truthful to the best of my knowledge. I understand that due to limited funding, all interested programs may not be
selected and that this interest form is not a guarantee that my site will be selected to participate in the School-Age
Rhythm & Rhyme program.
Owner/Directors Signature: ___________________________________ Date: __________________________

Please return interest form to Harnett County Child Care Resources no later than Monday, June 15, 2015.
North Carolina State University and North Carolina A&T State University commit themselves to positive action to secure equal opportunity regardless of
race, color, creed, national origin, religion, sex, age, or disability. In addition, the two Universities welcome all persons without regard to sexual orientation.
North Carolina State University, North Carolina A&T State University, U.S. Department of Agriculture, and local governments cooperating.