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MONTH ___________________ Enrollment Forms must be sent along with this form.

2008-2009
COMMUNITY CHILDCARE FOOD SUPPLEMENT, INC.
912-443-9995 PHONE 912-443-9997 FAX

________________________ TELE. NO. ________________


Please update this document every time your day care facility enrolls or terminates a child. Thank you.
Child’s Name & Address Phone Date Date Exited Date of Provider
Numbers Entered Birth Initials
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

THIS FORM SHOULD BE UPDATED REGULARLY. THE OFFICE MUST RECEIVE THIS FORM WITH EVERY
ENROLLMENT CHANGE. THIS FORM SHOULD BE SENT IN WITH ALL ADDITIONS TO THE DAY CARE AND ALL
ENROLLMENT EXITS. EACH TIME A NAME IS ADDED TO THE ATTENDANCE SHEET WE MUST RECEIVE THIS FORM
ALONG WITH THE NEW ENROLLMENT FORM. PLEASE CALL THE OFFICE IF YOU HAVE ANY QUESTIONS. THANKS.

CACFP
DCH

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